My Prozac Anniversary

1707-40In a few months, I’ll celebrate my 12th anniversary. On August 27, 1993, I walked into the Walgreen’s pharmacy at California Pacific Medical Center and handed the pharmacist my prescription. I’d just begun therapy for severe clinical depression, and my physician at the hospital’s outpatient Psychiatric Clinic believed I was a promising candidate for anti-depressants.

Even in the state I was in—deep despair—I knew I was crossing a line I couldn’t uncross. I was admitting to the world and to my insurance company that I had a “mental illness”. I was about to take a psychiatric drug. These were two things I had avoided for almost 40 years, but now I had reached the end of my ability to function. So after years of recurring episodes of depression—each time more severe– thwarted ambitions and sabotaged relationships, self-help books by the dozen, macrobiotics, EST, flower essences, chanting, meditation, prayer, herbs and positive thinking, it had come to this moment in a drug store. The pharmacist was counting out the 30 green and white capsules that Dr. Bhakta believed would be my ticket back to the land of the functioning.

When she told me that she thought Prozac would be the best choice of drug for me, I was a bit disappointed. Prozac, the happy pill. Prozac, the punchline of so many jokes. Prozac, the drug for the ordinary depressed person. I was hoping she’d recommend a more obscure drug, but Prozac was it.

I carried the little amber bottle down the hill to my studio apartment in the Marina, and set it carefully down on the counter. It was early afternoon, and I’d been instructed to begin taking the capsules the next morning. Tomorrow, I hoped my life would start again.

Prozac, and its sister drugs Paxil and Zoloft [all SSRI's—Selective Serotonin Reuptake Inhibitors], work very slowly. They usually take from five to six weeks to begin working. I knew this, and knew that the next morning’s dosage might be the first of many. It was the first of thousands. For the past 3,650 days, my morning routine has included an anti-depressant. I’ve taken a couple of “drug holidays” in that time [the euphemistic phrase doctors use for taking a medication break], but it was clear I was one of the patients for whom such holidays were contraindicated.

I’ve tried other drugs. Prozac has its side effects, so I switched to Paxil for a while. That didn’t work, so I tried Wellbutrin, and that worked OK for a couple of years. But nothing has worked as well as Prozac, and a couple of years ago, I resumed taking it. By then it was off patent and available by its generic name of fluoxetine. Some of the tabs weren’t even green and white, but I still call it Prozac.

There’s a stigma attached to psychiatric drugs. Taking them isn’t necessarily something you’d boast about; I’ve never been ashamed or kept it a secret. The PC thing is to say it’s no different than having to take a thyroid pill or a shot of insulin or a beta-blocker every morning. After all, clinical depression is a medical condition that is treated by medication.

True, and yet no one has to justify insulin or receive unsolicited advice about cheering up or improving one’s attitude in lieu of thyroid medication. There’s also the misguided belief that psychiatric drugs are somehow “happy” pills and make every day a walk in the park.

Nothing could be further from the truth. What they do—when they work [and they work in about 75 per cent of patients]– is bring to you back to normal or average. In some ways, it’s utterly prosaic. In other ways, the ways I appreciate most, it’s a small miracle. For me, and for millions of other depressed folks around the world, it’s changed our lives for the better.

It’s easy and fashionable to bash “big pharma” and mistrust the motives of giant drug companies. But for some people—and I am one of them—the only thing that works for the disease of depression is a psychiatric drug. I wish it wasn’t so. If I could treat my depression by drinking bancha twig tea or eating seitan or reading Dr. Phil, that would be nice. But I can’t.

Every day I thank the scientists at Eli Lilly for coming up with fluoxetine. They saved my life.

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