Lilly Knew About Prozac Risk in the 1980s

The need to re-invent the wheel every few years always amazes me. This headline has occupied the CNN news all day. Every time it is run, I have a gut response that is becoming a mantra at this point: "Don't throw symptoms away until you know the purpose they serve!"

In the 1980s I was very new to mental health "in the trenches" work. I worked with the Greater Manchester Mental Health Center in Manchester NH as a residential and crisis program manager. It was great training and I was fortunate to have excellent supervision and learning opportunities through my boss, Diane Langley, RN, and the mental health center treatment team staff.

Prozac hit the trade near the end of my 5 year tenure at GMMHC. The VERY FIRST information we learned was that the manufacturer and the psychiatrists said ANYONE with a bipolar type disorder or an agitated type depression SHOULD NOT be prescribed this medication because of the risk of their flipping into mania from vegetative depression. Now, if that information came into the prescribers' hands in the 1980s, how can it have "slipped" the minds of practitioners since then? How would prescribers get the information in a manner sufficient to warn other practitioners and patients unless the company gave it to them? So, if it was known then, and if the information came from the manufacturer, how can there be a furor over "secrecy" now?

Anyone with more than two brain cells can figure out that an SSRI is activating, hopefully improving overall brain function to reduce depression related anxiety and agitation from cortical underarousal as well as to lift slowed function from the same source. It is not a great choice for those who present as depressed but who may be developing and maintaining such symptoms to keep the lid on rage, or reactive fear and aggression which is a core of over half the clinically depressed patients I see in my practice.

Mood instability MUST be evaluated IN CONTEXT before a decision is made to prescribe any medication. Lifestyle, substance use, level of exhaution and sleep deprivation need to be adjusted FIRST or, less preferred, concurrently with slow initiation of antidepressants.

There is NO EXCUSE for providing an SSRI without knowing the context and function of the symptoms. Most importantly, symptoms should NEVER be reduced until there is knowledge of what lies beneath and risk assessment should the lid come off.

We must stop telling people they have a right to feel good and help them encompass feeling bad as acceptable and motivating toward personal change. Our current culture is antithetical to experiencing a sense of safety or tolerance of added distress without watching and experiencing the tower of "I" shatter. Until we choose a social and political path of peace and safety, all the pills in the world are a waste of money and are potentially lethal.

Wooden Shoe