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Original Post

Selective Serotonin Reuptake Inhibitors (SSRIs) is a class of popular antidepressants of which Prozac is the most famous member. Serotonin is a neurotransmitter at the heart of our neural information system with receptors spread through out the body. Interestingly, there is a concentration in the heart – providing a link between cardiac disease and the depression that often accompanies it. People with "low" levels of Serotonin (there is as yet no direct way of measuring this in patients) take SSRIs to inhibit the reuptake of Serotonin at the receptor site increasing the levels of Serotonin the neural synapse and over time often having a powerful mood elevating effect. Culturally, the drug has become a seemingly animate force in our public dialogue about medication and mood disorders in books such as "Listening to Prozac" and "Prozac Nation."

Recently, in the UK a meta-study from the Public Library of Science was released and reported in the Guardian (February 26, 2008) causing quite a stir. The study examines many past studies not released to the public and compares them with the bulk of studies funded by drug companies that were, and comes to the surprising conclusion that Prozac is not proven to be much more effective than placebos. This comes at a time when the British National Health care service is putting much more funding into making cognitive based talk therapy available to their clients. The UK, despite widespread use of Prozac, has always had a slightly more critical view of the drug than in the United States; the first studies on Prozac’s possibly increasing the incidence of suicide in teenagers being first publicized there.

A follow up article in the Guardian (sited below) with contributions from writers with different perspectives and experiences with the drug is a good collection of opinions in response to this announcement. Core points of a debate about the widespread use of mood stabilizers are touched on in personal ways that are worth reading. There are clearly some people whom Prozac has “saved” their lives made it possible to function and participate in daily existence. There are others who through the loss of a teenager through a suicide while taking Prozac, feel this news as an even harsher indictment of a rush to legitimize a drug treatment, without full knowledge of effectiveness or disclosure of side effects. Therapists wonder over the placebo effect, and argue eloquently that a drug does little without talk therapy even as it is increasingly prescribed by GPs with no psychological backup. There is the ongoing critique that drugs are a much easier answer to these problems and more time efficient, (I might also add making someone a lot more money than talk therapy which is hard to commoditize). There is also a debate as to whether antidepressants while alleviating surface symptoms, actually help people tackle underlying causes of depression: death of a loved one, low self-esteem. And even how define the spectrum of "mental" illness or mood disorder, with the diagnosis of depression being a relatively recent phenomenon, perhaps shaped by the development of drugs to treat it. But over 40 million people are taking the drug, which while it has become a little like worn out Hollywood starlet of sorts, still deserves deeper thought.

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