It used to be that nothing killed cocktail party conversation like announcing that I’m a psychiatrist. Anticipating a brutal psychological interpretation, people practically left treadmarks as they hastily ended our previously pleasant exchange.
Then there was Prozac.
Prozac was approved by the FDA as medicine for treatment of clinical depression, although concerns were later raised about it creating aggression in some people. However, it has been touted lately as a method to change personality traits such as shyness, personality rigidity and to enhance energy and concentration.
Now people flock to me in droves. Prozac, cocktail parties and I have been on a roller coaster. First it was the biggest medical breakthrough since penicillin. Then it fell from grace with a resounding thud. People wanted to know why any doctor would ever prescribe that medicine that “made you tear somebody’s face off.” My staunch defense of Prozac left many a new acquaintance looking at me as if I had just advocated early parole for Charles Manson.
Now it’s the hottest thing around again. This time, though, Prozac is being compared not to penicillin but to circuit weight training, liposuction or a radical perm. “Cosmetic psychopharmacology,” is what psychiatrist Peter Kramer calls it in his book “Listening to Prozac” (Viking, $23). Who wouldn’t want it?
Feeling bad? Kids on your nerves? Afraid to ask your boss for a raise? Get your doctor to give you Prozac.
Don’t get me wrong. I’m thrilled that treatment for depression is less stigmatized. We’ve got great new antidepressants that work well with mininal side effects. I don’t want to go back to the days when only begging, sweet-talk and authoritarianism could convince a clinically depressed but ashamed patient to take medication. Recognition of the neurochemical basis of major mental illnesses is long overdue.
Prozac is a great medication, usually well tolerated, and a highly effective treatment component for diseases which commonly afflict women: depression, anxiety and bulimia nervosa.
But it’s also incredibly expensive, not uncommonly interferes with women’s sexual pleasure (men’s too) and may cause jitteriness, nausea, headaches or insomnia. Because it only has been out since 1988, no one can say yet what the consequences of long-term use might be. Probably we won’t find any, but the history of modern medicine is filled with mental-health cure-alls that were not as simple as they seemed.
Like penicillin, Prozac will not cure all that ails you. If you read a recent Newsweek article, you learned that “. . . not everything we feel, let alone everything we are, is shaped by too much or too little of some polysyllabic brain chemical.” Excuse me? Not everything? Look around. We have children being raised in urban war zones, women get paid about two-thirds of what men make for the same jobs. I assure you, you and I and all our grandchildren will be dead long before polysyllabic brain chemical adjustments cure even most of the condition of human misery.
Is the rush to treat personality traits with antidepressants a woman’s issue? You bet it is. Look at some of the traits targeted for correction by Prozac: compulsive shopping, shyness, sensitivity to rejection, obsessive housecleaning.
Can’t we find a better solution to socializing women to define themselves by romantic relationships than medicating those who cannot tolerate being alone? Valium and Librium didn’t pan out as the answer to the frustration and isolation many women attribute to the burdens of child-rearing. Couldn’t “mother’s little helper” (as these pills were called in the ’50s) be Dad instead of Prozac?
Women suffer clinical depression at a rate twice that of men, only in part due to biologic factors. Depression is astonishingly common in women: One in five suffers at least one episode. The stresses of childbearing and childrearing, sexual victimization, domestic violence, the crisis of unplanned pregnancy and devaluation of women’s childrearing and housekeeping roles all contribute to increased vulnerability to mental health problems.
Because psychiatric illnesses are common in women and generally undertreated, breakthroughs such as Prozac offer truly meaningful benefits for women’s health. But lest we be condemned to repeat the past, let’s practice a bit of caution before moving from treating diseases to correcting unwanted personality traits.
———-
Dr. Valerie Raskin is director of the Women’s Psychiatry Service at the University of Illinois at Chicago.
