There’s a pill for everything, they say, and arguably it’s Prozac — or using its less digestible Rumpelstiltskin generic name, Fluoxetine. Prozac lost its patented crown in 2001 simultaneously wiping billions from its manufacturer, Eli Lilly’s share value after a long and profitable career that started in 1986.
The psychiatrist Dr Peter D Kramer, who investigated the drug in his 1993 New York Times best seller, ‘Listening to Prozac’ later described its trajectory in terms closer to a rockstar than a pill when he wrote: “Renown, followed by rumors and then notoriety, scandal, and lawsuits, and finally a quiet rehabilitation.” This is the same doctor who placed it in a category he called ‘cosmetic pharmacology’ — essentially a pill fix for modern day misery.
The quiet rehabilitation Kramer points to is, I suppose its admission to generic status because 19 years after it lost its patent in 2020 it was the 25th most commonly-prescribed medication in the United States, with more than 23 million prescriptions — the Prozac nation within a nation no less. It has been rehabilitated and re-purposed to cover all sorts of other malaises, including obsessive compulsive disorder (OCD), and panic attacks. Apparently, there’s even a beef-flavoured version for depressed dogs if you believe it.
Of course, since its arrival, big pharma have introduced any number of other branded SSRI’s, the class of drugs which return the dysfunctional back to functioning and productive members of society, but it still retains its crown as the original and best despite a long list of ‘adverse effects’ which include:
‘Abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dizziness, dry mouth, dyspepsia, fatigue, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilation, and yawning.’
I write about it because I too have made my application to the Prozac nation. I’m one week into the journey and I was told by the prescribing psychiatrist that it takes at least two weeks before I reach ‘cruising altitude’ (not his words) and which I imagine is a state of ‘no highs, no lows but even flow’.
From that perspective, I thought to write about it as a personal journey since, for one reason or another, it will change the way I interact with the world — at least for the six months I intend to take it. Getting to this point was not straightforward either. I had deliberated in my own mind for months about that first meeting with the prescribing doctor in the hope of securing a green light for talk therapy. The threshold for me was a high one because I was raised with the cultural imprint of the British stiff upper lip, which makes talking about or even acknowledging emotional/psychological trauma problematic.
Meanwhile at the psychiatrist’s reception, having detailed my general state of anxiety (raised significantly since February 24, 2022), broken sleep, and persistent low mood, (and naïvely thinking that he would be receptive to my request for said therapy), he quickly steered the conversation to SSRIs.
I would not say he was dismissive of therapy but did suggest that it was difficult to obtain, didn’t always set people on the right track and in its worst instance, wasted a lot of time. Instead, he spoke for some time about the power and effectiveness of SSRI’s and in the same breath, he mentioned Fluoexetine, (which also went under my radar initially without its brand name being mentioned).
I did question his assessment, but he was quite adamant on the subject and the consult ended there with the prescription of not one but two antidepressants and a second meeting one month hence to see how it’s all going.
A 45 minute consult with a stranger is a short time in which to assess the need for any kind of intervention, even for a seasoned professional. Admittedly, it’s a luxury to be able to see a top level professional in the first place but it feels like a failure to fall back on pharmaceuticals without the possibility of counselling. I did, however, commit to keeping an open mind on the subject but later at home hesitated on taking two clearly powerful medications at the same time.
So here I am on Fluoxetine and I’m feeling my way every day. Dropping a 20 mg pill every day to regulate your mood is a strange and almost foreign concept. It’s good to remember though, that powerful drugs like caffeine and nicotine are also enjoyed daily by millions albeit in non-pharmaceutical doses wrapped up in delivery systems that have heightened cultural status and history.
But taking a pill is a different kind of choice and it’s a choice you are obligated to make every day as part of your regimen. And as said, it meets all the criteria of any kind of drug taking — altering perceptions, building tolerance, maintaining supply, and achieving an acceptable level of normality with the drug.
Like all SSRIs, the drug targets serotonin in the body which is the complex and powerful neurochemical messenger responsible for modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and constriction of the blood vessels.
In the brain Fluoxetine blocks the serotonin reuptake transporter between synapses, which ultimately results in sustained levels of serotine in certain brain areas. Fluoxetine is also interesting in that it also interacts with another receptor called 5-HT2C which, excited by its presence initially (and paradoxically) leads to heightened states of anxiety and depression (its use in young adults is potentially a trigger for suicide and self-harm according to some studies). However, the two-week sweet spot is achieved when after over-excitation, the receptor downregulates leading to an additional feel good increase in noradrenaline and dopamine levels in the business end of the brain, the prefrontal cortex.
One week in, I can share with you a few empirical observations about my journey so far. On day one, not long after I took the first pill, I noticed a shift in my vision. The only way I could describe it, is if you have ever been to an optician for sight testing. At the point where they are establishing the fine tune of your lens, they slot interchangeable lenses into your view and while subtle, you notice the difference and flag it. I’ve noticed a permanent but subtle shift in my viewing lens.
Contrary to what many say, I experienced not a drop in appetite but an increase — not so much as to be alarming but there was a definite craving for feel good carbohydrates which I had managed to keep a lid on before. Also, my stomach was both noisier and over-active. I suppose it could be to do with the fact that the GI tract hosts the Enteric Nervous System (ENT) or second brain replete with neurons and must by default also be affected by SSRIs. More than 90% of the body’s serotonin lies in the gut, after all.
Dreaming is not abnormal, but it has a slightly more lucid quality to it — as if I were more in control of the narrative. This was at least observed in the first few days of taking it. Sleep felt restful but also shorter with higher levels of alertness the minute my feet touched the floor. I also felt more tired at points during the day but this seems to be passing now. All in all, I am aware of a subtle shift in consciousness but have yet to understand it.
On an emotional level, I feel OK but noticed a certain kind of blunting at both ends of the scale — the even flow I mentioned at the beginning of this piece. I’m not sure if by removing the darkest and lightest of the fifty shades of grey that this is the tradeoff I am willing to make, if I end up in a perpetual thirty shades of beige. Time will tell and it all might be resolved by day 14 and onwards when the lights apparently go on.
This points me back to the role of doctors as gatekeepers to the mind regulated worlds created by big pharma. In the worst cases of depression, these are clearly powerful and useful tools to break mental impasses. The question is though (and it’s obviously been considered by better minds than my own) whether it is ethically sound to give drugs like Fluoxetine to people with mild depression or anxiety as a palliative to what is, essentially the modern human condition.
Mentally well people don’t need drugs and as animals, albeit complex ones, we should be able to navigate the world in their absence, instead letting nature be our balm, as one recent Finnish study concluded.
Unfortunately, though, as the countryside empties and cities swell, nature gets further and further from us. Instead, we live in a walled age of anxiety so shouldn’t we all be taking these drugs? Should it be regarded as a palliative to mental dysfunction in the same way that for example that fluoride is to tooth decay? Who questioned the US authorities in the 1940s they started public water supply fluoridation — a practice that is now applied to water supplying 6 percent of the global population, and incidentally two-thirds of Americans. I won’t go down that conspiracy rabbit hole, but suffice to say, that the US authorities of the 1940s played faster and looser with public regulations than they do today and that certain practices become by habituation, unquestioned, even welcomed.
So, I am now trucking down the road now towards those sunny uplands with Fluoexetine as my constant companion. Will it change who I am as a personality shaving off those characteristics that might otherwise be deemed unwished for — things like melancholy and brooding anger? I don’t know. In one week’s time, the door may swing open as I am admitted to Prozac nation, its residents like me smiling with confidence, pupils fixed and dilated, eager to welcome another convert to their midst.
Watch this space.
