Back in 1994, Elizabeth Wurtzel in “Prozac Nation” wrote,
As Prozac becomes viewed as a silly drug for crybabies… the people whom it might really help – the ones who need it – will start to think that Prozac won’t help them. In the rape-crisis debate that currently rages, many feminists argue that too loose a definition of rape results in not taking ‘real’ rape seriously, while others claim that anyone who feels violated was violated – and what gets lost in all the screaming and yelling is that there are all these real people who are raped and are in terrible pain. It seems entirely possible to me now, given the tone of so many of the articles about Prozac, that people will forget how severe, crippling, and awful depression really is.
She was right to be angry. Prozac can help some people with severe depression. It’s also useful in the treatment of eating disorders such as anorexia. What it’s not good at is treating people who aren’t depressed, who actually need additional support, a talking-based therapy or practical help out of a difficult and stressful situation. So why the non-story?
Others have already written on buried data and how clinical trial results can be given a positive spin. Others have suggested that doctors are too quick to reach for the prescription pad. However, when there’s a shortage of psychological therapists and a year long waiting list, doctors don’t have much choice when a patient needs help now.
As usual, the story’s somewhere between the lines. Elizabeth Wurtzel touches on it,
The secret I sometimes think that only I know is that Prozac isn’t that great…. after six years on Prozac, I know that it is not the end but the beginning.
Prozac only makes the symptoms of depression easier to cope with. It does not cure the underlying cause. If you appreciate that limitation, then Prozac becomes a coping strategy, something that makes the depression easier to live with whilst you begin to delve into the underlying cause. In effect, it’s a drug equivalent of cognitive behavioural therapy (CBT) which arms you with coping strategies but doesn’t treat the underlying cause. Both make it easier to live with depression but neither will cure it.
The real story and the real problem is the tendancy to latch on to the newest apparent tool (whether drugs or therapy) for a class of mental health problems as a one-size-fits-all cure. You wouldn’t buy clothes on that basis. So why the rush to treat people like that?
The real answer lies in treating individuals individually and accepting that drugs will work for some, some will respond better to therapy and some need a combination of both.