Prozac
Are drugs for treating mental illness being used too freely?
By Mary H. Cooper

Officially, Prozac has been approved only for treating two serious mental diseases: clinical depression and obsessive-compulsive disorder. But millions of people in the U.S. are turning to the distinctive green-and-white capsules just to pull themselves out of the dumps. They've helped make Prozac one of the world's most widely prescribed medications. Prozac's extensive use has sparked an intense debate. . . .

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Prozac and the Treatment of Serious Mental Illness

Prozac has received final approval from the Food and Drug Administration (FDA) for the treatment of two serious illnesses and preliminary approval for a third:

Depression: The FDA first approved Prozac for treating clinical depression, a condition far more serious than the “blues” that everyone experiences from time to time or the temporary grief that follows a major loss. This severe form of depression strikes an estimated 15 million Americans each year and will affect more than 8 percent of the population during their lifetimes. A milder form of depression is called dysthymia. The American Psychiatric Association defines severe depression as the almost constant presence of five or more of the following symptoms for at least two weeks:

-- depressed mood most of the day, nearly every day;

-- loss of interest or pleasure in previously enjoyed activities;

-- significant changes in weight or appetite;

-- sleep disturbances (oversleeping, waking up early, trouble falling asleep);

-- feelings of guilt, helplessness or lack of self-worth;

-- decreased ability to concentrate;

-- fatigue or loss of energy;

-- anxiety, restlessness or slowed activity;

-- hopelessness or thoughts about death or suicide.

Obsessive-Compulsive Disorder: This condition was recently approved by the FDA for treatment by Prozac. OCD, as it is known, is characterized by recurrent, unpleasant and unwanted thoughts (obsessions), or repetitive, ritualistic behaviors that a person feels driven to perform (compulsions). OCD affects about 4 million Americans, or 2 percent of the population. A person with OCD may experience obsessions or compulsions alone or in combination. Patients typically recognize the irrationality of their thoughts or behaviors but are unable to control them. Typical obsessions include:

-- fear of dirt and contamination;

-- fear of acting on violent or aggressive impulses;

-- feeling overly responsible for others' safety;

-- inordinate concern with order, arrangement or symmetry.

Typical compulsions include:

-- washing, cleaning, counting, arranging, checking, saving and repeating.

Bulimia: In April, an FDA panel recommended approval of Prozac for treatment of bulimia nervosa, a chronic eating disorder. Uncommon in men, bulimia may affect as many as 2.8 percent of American women during their lifetimes, mainly between the ages of 18 and 35. Bulimia is accompanied by some or all of the following symptoms:

-- recurrent episodes of binge eating;

-- feelings of lack of control;

-- self-induced vomiting;

-- use of laxatives or diuretics;

-- strict dieting or fasting or vigorous exercise to prevent weight gain;

-- an average of at least two binge-eating episodes a week for at least three months;

Sources: Eli Lilly and Co.; U.S. Public Health Service