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Listening to Prozac.

Until the science of genetics exploded with clues and explanations of brain functioning and the mind's vagaries, mental health practitioners had few options in dealing with depression and other mental disorders. Either psychoanalysis or tranquilizers were the treatment of choice. Most psychiatrists preferred the latter, some employed both.

As mind-altering drugs multiplied, with pioneers such as meprobamate (Miltown) and chlordiazepoxide (Librium) practically bypassed, particular chemicals in the brain were discovered that responded in varying ways to these medications. Psychiatrists were given a weapon with which to fight the mental dragons.

Genetics opened new vistas. The logical principles of psychoanalysis, no matter how neatly they made theories fit, could not cure an inherited genetic disorder. Only a particular drug, and only in a limited percentage of cases, could alleviate suffering caused by panic disorders, clinical depression, Tourette syndrome and obsessive-compulsive disorders.

In Dr. Kramer's book, one particular drug, an antidepressant, is extolled as an example of what he considers the possibility of a "new world" opening for some of its patients. Prozac (fluoxetine) heralded and condemned by various critics, receives unreserved praise from the author.

At first glance, the book seems like a flood of praise for a high-profile drug -- almost like an advertisement. But Kramer has a more compelling tale to tell. He relates case histories of patients with various personality disorders who not only found relief in Prozac but also experienced the "lifting of a curtain" that had enshrouded their personality. All of the patients not only had changes that made them "better than well," but brought out changes in mood, assertiveness, sociability and risk-taking that astounded the doctor.

Dr. Kramer is convinced that psychiatry is often enhanced by medications. He raises the point whether a drug's ability to change brain chemistry (for example, serotonin, whose flow, when erratic, can cause the mental disorders mentioned above, to become a force for unlimited mental achievements) will consequently unleash repressed joy, happiness and positive energy.

If Dr. Kramer's enthusiastic view of Prozac is justified, society may be faced with a future in which psychiatrists will extend their influence beyond the treatment of mental disorders into the more controversial areas of personality enhancement. The author refers to the dawning of an era of "cosmetic pharmacology." The latter, we must assume, has no comparison to hallucinatory drugs, which are instigators of temporary, but often addictive, mood raising.

Prozac, initially approved by the Food and Drug Administration for the treatment of depression, has recently been sanctioned to treat other serotonin-related malfunctions such as obsessive-compulsive disorder.

For all of its meteoric success, Prozac has been the center of several storms. "Prozac enjoyed the career of a true celebrity -- renown, followed by rumors, then notoriety, scandal, and lawsuits, and finally a quiet rehabilitation," Dr. Krammer recounts. "Prozac was on 'Nightline' when you went to sleep and on the 'Today' show when you awoke."

"The backlash began," he remembers, in the great tradition of tarnishing the idol's lustre. People were taking the drug for weight loss and for binge eating, for premenstrual tension and post-partum blues. These were women mostly, and the question arose, was Prozac, Miltown, or Librium the 'mother's little helper' from which we expect too much and about which we know too little?"
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Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Publication:Nutrition Health Review
Article Type:Book Review
Date:Jun 22, 1993
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