Prozac Backlash - a preliminary view

Published earlier this month, Prozac Backlash is a US psychiatrist's account of "the dangers of Prozac, Zoloft, Paxil, and other antidepressants". Topics reviewed in Part One are: risk of brain damage; problems of withdrawal, dependence and loss of drug effect; sexual dysfunction; and "startling new information on suicide and violence". In Part Two, Dr. Joseph Glenmullen discusses "balancing medications with alternative approaches". These are issues of much interest to visitors to this website, and should concern many others besides.

And probably this book will reach a wide audience, because Dr Glenmullen explains the evidence in an intimate, popular and quite personal style. Though it discusses people suffering on antidepressants rather than blooming on them, in this respect, Glenmullen's book invites comparison with Listening to Prozac (Kramer, 1994). It is not likely to be ignored.

The immediate point of interest is the unfolding response. The book jacket points to strong support from some impressive sources (Healy, Moore et al). Elsewhere, there has been a furious, initial reaction from Eli Lilly & Co - though now there seems something of a lull, perhaps because of growing support in kind (Rosenbaum et al). The polarisation is extreme.


Joseph Glenmullen has done an outstanding job in portraying the real-life experiences of patients and using them to illustrate the scientific facts. If you really want to listen to Prozac, this is an eye-opening account that should not be missed." (Thomas J. Moore, George Washington University Medical Center, author of Prescription for Disaster: The Hidden Dangers in Your Medicine Cabinet)

"Dr. Glenmullen has assembled from every possible source the clinical and scientific evidence that there are costs as well as benefits to Prozac and related drugs. He warns us that no one really knows the long-term consequences of these chemicals on the brain. His well-written book will surely be damned by the drug companies and their paid scientists. But Dr. Glenmullen, like many dedicated clinicians, has learned that if you keep on listening to Prozac,' you cannot help but recognize the danger signals." (Alan Stone, M.D., Professor of Psychiatry and Law, Harvard University, Former President of the American Psychiatric Association)

"Dr. Glenmullen documents the carefully concealed dark side of these highly touted drugs and makes a strong case that alternative treatments yield equal benefits at much less risk. Provocative and hopeful, Prozac Backlash is a must-read for anyone on the drugs." (Leon Eisenberg, M.D., Professor of Psychiatry, Harvard Medical School)

"Dr. Glenmullen's book is a refreshing antidote to the limited information which has been available to the public. His book should be read by anyone on Prozac, Zoloft, Paxil, and other antidepressants; by anyone with a family member or friend on the drugs; and by those who prescribe them. Prozac Backlash is a gripping and disturbing account of psychiatry at the start of the new millennium. (David Healy, M.D., author of The Antidepressant Era)


"Prozac maker Eli Lilly and Co. calls the 383-book 'a collection of half-truths, omissions, errors and personal anecdotes' … its officials worry that 'the book is a fear-mongering publication that may prompt those with medication to abandon their medication and seek medically unproven alternatives.' In that regard, the book is 'dangerous,' added Lilly spokesman Jeffrey G. Newton." (J. Swiatek: Book slams Prozac as overused, dangerous, The Indianapolis Star, 6 April 2000)

The author's "allegations provoked sharp responses from Dr Steven M. Paul, one of Lilly's top scientists, who is being made available for news media interviews to combat charges in Glenmullen's book. 'We've never found anything like that,' Paul said of the notion that Prozac might be toxic to the brain. 'It couldn't be further from the truth.' … Paul referred to parts of the book as 'ludicrous' and 'unbelievable' and the book itself as a diatribe.' (Ibid)

"'It's a dishonest book, it's manipulative, it's mischievous,' said Dr. Jerrold F Rosenbaum, professor of psychiatry at Harvard Medical School . And that's an opinion he reached after reading only the first 80 pages, said Rosenbaum, who faulted Glenmullen's first chapter for saying Prozac can cause severe facial tics. … 'It's not a side effect of the drug that occurs at a frequency where you should even inform patients,' Rosenbaum said … Rosenbaum also questioned a book-jacket mention of Glenmullen as a clinical instructor at Harvard Medical School. 'I've been at Harvard Medical School 25 years and I've never seen, heard or met the guy.'" (Ibid)

"The National Mental Health Association today voiced concerns over what it called misleading statements in a new book that claims antidepressant medication is over-prescribed and causes serious side-effects. The NMHA also expressed concern that the book, Prozac Backlash, could discourage people from seeking treatment … 'The truth about depression and its treatment is just the opposite of what the book claims,' noted Mike Faenza, President and CEO of NMHA. 'In fact, clinical depression remains under-diagnosed and under-treated. And the new generation of medication for depression is much safer and more effective than those of the past.'"

"NMHA's criticism of the book …was echoed by two leading psychiatrists, who said that the book's messages were misleading and irresponsible … 'In cases where Dr Glenmullen quoted studies published by me, he quotes the work out of context to fit his needs,' said Anthony Rothschild, M.D., professor of psychiatry at the University of Massachusetts Medical School. 'This book is misleading and does a great disservice to people with depression. The very medications that the author claims are overused are, in fact, well studied, closely scrutinized and closely regulated.' … Dr Glenmullen goes well beyond the published research on the side effects of these newer antidepressant medications,' warned Harvey Ruben MD MPH, clinical professor at the Department of Psychiatry at Yale School of Medicine. 'His messages are an irresponsible deterrent to those seeking help from depression, and border on inflammatory journalism.'"

Last week, I emailed the Indianapolis press office of Eli Lilly, asking for a copy of any statement the company had made about the book. The company did not respond. So, I'm left wondering to what extent the company's reaction is a response to the book, as opposed to a defence of its business?

That question arises partly because Eli Lilly's immoderate response seems to have been reported only in the Indianapolis Star, also because it comes at a time when the company is struggling quite hard. Lilly is the No 1 corporate presence in Indiana and a major employer and benefactor in the State - but it has not been faring well and there is much local concern about the risk of a take-over. "Yes, there are omens of acquisition, including the fact that Lilly's stock has been hovering at $54 a share, down from a $97 high just a year ago. That makes the Indianapolis drug company a bargain" (A. Neal, Taking stock of Eli Lilly, The Indianapolis Star, 9 March 2000). Locally, the threat seems huge:

"Imagining life without Lilly is so unpalatable that most of us can't even do it. 'I don't like it when you talk like that,' says John Myrland, president of the Indianapolis Chamber of Commerce. 'If we were to lose Lilly … it fundamentally changes the whole community." … 'It's like your child coming up and asking, "Dad, what if there weren't any trees?"' says Jeff Swiatek, The Star's Lilly reporter. 'How do you answer something like that?'" (Ibid)

The response to this book from the scientific community will, no doubt, be greatly influenced by commercial considerations. Whether Lilly and/or other manufacturers will respond directly to the evidence in this book remains to be seen. If not, they would seem to bear even more responsibility for the backlash now upon them.

Indeed, what does it mean that the SOCIAL AUDIT website has attracted no published criticism from the antidepressant manufacturers? For over two years, hard evidence of major problems has been mounting on this website, and its discussion pages give ample evidence of many in distress. Manufacturers of antidepressants, and their many agencies, are frequent visitors to this site - yet there has never been any response from any of them.

Perhaps the point is that the manufacturers are concerned about the hard evidence ultimately for its impact on their business destiny. If they can ignore or neutralise bad news and accounts of human misery, they will surely try. To this extent, at least, they invite provocation of the kind Glenmullen's book provides and, my view, richly deserve it.

Charles Medawar
April 2000

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