cheap buy phentermine prozac prozac nation christina ricci, prozac suicide, effect of prozac on children, prozac nation ricci, prozac and weight loss, prozac overdose, side effects prozac, side effects of taking prozac, prozac dose side effect, prozac nation review
| prozac discount prozac prozac fluoxetine buy phentermine prozac order prozac online side effects of drug prozac side effects of quitting prozac effects of prozac prozac side effects side effects of taking prozac side effects of high doses of prozac prozac and its side effects side effects of going off prozac prozac side effect prozac withdrawal symptoms prozac for dogs prozac dosage prozac and alcohol prozac vs zoloft prozac information prozac and weight gain cat prozac prozac nation dvd prozac alcohol stopping prozac potatoes not prozac stopping prozac cold turkey prozac weekly free research papers on the effects of prozac prozac nation prozac dangers prozac nation book report effect of prozac on children prozac nation ricci prozac suicide prozac withdrawal prozac nation movie prozac lawsuit prozac cartoon side effects of prozac christina ricci prozac nation prozac nation christina ricci prozac dose side effect christina ricci prozac withdrawal from prozac prozac getting off prozac and wellbutrin together prozac overdose prozac nation the movie prozac withdrawal symptoms flu zoloft vs prozac prozac nation review prozac and amitriptyline for sleep book prozac nation ricci prozac nation effects of prozac and dui quitting prozac pros and cons of prozac prozac and side effects prozac for children weaning off prozac side effects prozac | prozac backlash Amazon.com: Books: Prozac Backlash : Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives YourStoreBooksSee All 31Product Categories Your Account | Cart | Wish List | Help Search | BrowseSubjects | Bestsellers | prozac backlash The New York Times®Best Sellers | Magazines | CorporateAccounts | e-books& docs | BargainBooks | UsedBooks Search Amazon.comBooks Web Search BooksMusicDVDVHSMagazines & NewspapersComputer & Video GamesSoftwareElectronicsAudio & VideoCamera & PhotoCell Phones & ServiceComputersOffice ProductsMusical prozac backlash InstrumentsHome & GardenAutomotiveBed prozac backlash & BathFurniture & DécorGourmet FoodKitchen & HousewaresOutdoor LivingPet SuppliesTools & HardwareApparel & AccessoriesShoesJewelry & WatchesBeautyHealth & prozac backlash Personal CareSports & OutdoorsToys & GamesBabyWish ListGift IdeasWedding RegistryBaby RegistryFree e-CardsIn-Store PickupFriends & FavoritesEarly AdoptersAuctionsOutletzShopsNonprofit Innovation AwardShort Film CompetitionMovie ShowtimesRestaurantsYellow PagesTravelSell Your StuffAssociates ProgramAdvantage prozac backlash ProgramPaid PlacementsWeb ServicesCorporate Accounts This item is prozac backlash not eligible for Amazon Prime, but over a million other items are. Join Amazon Prime today. Already a member? Sign in . book Information Explore this item buying prozac backlash info customer reviews editorial reviews search inside Share your thoughts write a review write a So You'd Like to... guide e-mail a friend about this item Rate this item Rate this item Listmania!Books about Prozac and other A...: A list by Joe O'Brien, Took Prozac for 5 yearsAdd your List READY TO BUY? 68 used & new from $0.95 A9.com users save 1.57% on Amazon. Learn how. Have one to sell? Don't have one?We'll set one up for you. Prozac Backlash : prozac backlash Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternativesby Joseph Glenmullen "Late in her therapy, Maura took to lying back in the chair prozac backlash in my office, so relaxed she looked prozac backlash as if she drifted into a..." (more) SIPs: other serotonin boosters, related neurological side effects, involuntary motor system, official product information, driven agitation (more) CAPs: Eli Lilly, Held Hostage, Bones Rattling Like Tuning Forks, Surmounting Anxiety, Unraveling prozac backlash Depression (more) Search inside this book Share your own customer images Availability: Available from these sellers. 68 used & new available from $0.95 Edition: Hardcover Other Editions: List Price: Our Price: Other Offers: Hardcover $25.00 $25.00 9 used & new from $7.95 Paperback $14.00 $11.20 78 used & new from $3.22 Customers who bought this book also bought The Antidepressant Solution : A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction" by Joseph Glenmullen The Anti-Depressant Fact Book: What Your Doctor Won't Tell You About Prozac, Zoloft, Paxil, Celexa, and Luvox by Peter R. Breggin Your Drug May Be prozac backlash Your Problem: How and Why to Stop Taking Psychiatric Medications by Peter R., prozac backlash Md Breggin Talking prozac backlash Back to Prozac: What Doctors Won't Tell You About Today's Most Controversial Drug by Peter R. Breggin Prozac prozac backlash and the New Antidepressants: What You Need to Know About Prozac, Zoloft, Paxil, Luvox, Wellbutrin, Effexor, Serzone, Vestra, Celexa, St. John's Wort, and Others by William S. Appleton Let Them prozac backlash Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and prozac backlash Depression by David HealyExplore Similar Items: in Books, in DVD Editorial Reviews Amazon.comIt seems like it was just yesterday that Prozac was a miracle pill, a medication that could not only make sick people prozac backlash well, but "better than well." By the end of the 1990s, Prozac and similar drugs--Paxil, Zoloft, and others--were being prescribed for everything from depression to anxiety to drug addiction to ADD. About prozac backlash 70 percent of prescriptions for these antidepressants were being prozac backlash written by family physicians, rather than psychiatrists. Dr. Joseph Glenmullen, a psychiatrist who has a private practice and also works for Harvard University Health Services, sees this antidepressant mania as dangerous, even reckless. He notes that these drugs can have severe side effects, including uncontrollable facial and body tics, prozac backlash which could be signs prozac backlash of severe and permanent brain damage. About 50 percent of patients suffer often-debilitating withdrawal symptoms from them, and about 60 percent end up prozac backlash with sexual prozac backlash dysfunction. And Prozac may make a small number of people homicidal or suicidal, or both. But there are alternatives: prozac backlash in Germany, for prozac backlash example, St. John's wort outsells Prozac 25 prozac backlash to 1, showing that doctors and patients there understand that the prozac backlash herbal remedy works as well as prozac backlash the synthetic ones for mild to moderate depression. [Editor's prozac backlash note: St. John's wort has been shown to interfere with the actions of the transplant rejection prozac backlash drug cyclosporin and the AIDS drug indinivir.] And diet, exercise, 12-step programs, and good old-fashioned psychotherapy can work well, prozac backlash too. Even for severe depression requiring medication, Dr. Glenmullen shows how the drugs can be used with other treatments and then discontinued after a year or less. Moreover, Prozac Backlash discusses exactly what depression is and isn't; Dr. Glenmullen reviews hundreds of scientific studies, and discusses numerous case studies from his practice and others. Because of that detail, medical professionals may be this book's most likely readers, but anyone prozac backlash who has been on an antidepressant, or is close to someone who is, will also want to give Prozac Backlash a careful prozac backlash read. The brain you save could prozac backlash be your own. --Lou SchulerFrom Publishers WeeklyIn recent prozac backlash years, a growing number of books, such as Peter Breggin's Your Drug May Be Your Problem, have sounded an alarm about the long-term dangers of popular new psychiatric medications. Glenmullen (The prozac backlash Pornographer's Grief), a clinical instructor of psychiatry at Harvard Medical School, joins their ranks with a lucid, wide-ranging prozac backlash survey of recent studies on the prozac backlash negative effects of antidepressants and their less-publicized alternatives. His title refers not to the growing skepticism toward psychiatric medications but to the brain's compensatory reactions to the artificial elevation of serotonin, including potentially permanent tics, dependence, sexual dysfunction, memory problems, sudden suicidal feelings and violence. In the first half of the book, Glenmullen focuses on four serotonin boosters known as the Prozac group, while in the second half, he explores the efficacy of individual, couples and family psychotherapy, herbal remedies, diet and exercise and 12-step programs. According to Glenmullen, clinical trials of drugs last as little as six to eight weeks, while side effects can take decades to emerge. In addition, he charges that a profit-minded pharmaceutical prozac backlash industry has under-reported side effects, misrepresented theories of "chemical imbalance" as fact and expanded diagnostic definitions to increase a drug's potential customer base. While his accounts of his own experience with patients is helpful, Glenmullen's most valuable contribution is his reporting on what little monitoring has been done. (Apr.) Copyright 2000 Reed Business Information, Inc. See all Editorial Reviews Product Details Hardcover: 383 pages Publisher: Simon & Schuster (2000) Language: English ISBN: 0684860015 Product Dimensions: 9.5 x 6.4 x 1.1 inches Shipping Weight: prozac backlash 1.4 prozac backlash pounds. Average Customer Review: based on prozac backlash 62 reviews. (Write a review) Amazon.com Sales Rank: #107,785 in Books (Publishers and authors: improve your sales) In-Print Editions: Hardcover | Paperback | All Editions Inside This Book New! Books on Related Topics | Concordance | Text Stats Browse Sample Pages: Front Cover | Copyright | Table of Contents | Excerpt | prozac backlash Index | Back Cover Search prozac backlash Inside This Book: prozac backlash Inside This Book (learn more) First Sentence: Late in her therapy, Maura took to lying back in the chair in my office, so relaxed she looked as if she drifted into a peaceful, tranquil state as we spoke. Read the first page Statistically Improbable Phrases (SIPs): (learn more) other serotonin boosters, related neurological side effects, involuntary motor system, official product information, driven prozac backlash agitation, disfiguring tics, drug proponents, cocaine elixirs, prozac backlash rebound irritability, attorneys for prozac backlash the survivors, drug advocates, amphetamine antidepressants, sexual side effects, type sedatives, electric shock sensations, managed care insurers, serotonin antidepressants, elevator phobia, major tranquilizers, antidepressant studies, causing suicide, herbal antidepressant, stifled anger, prescribing guidelines, induced prozac backlash sexual dysfunction Capitalized Phrases (CAPs): (learn more) Eli Lilly, Held Hostage, Bones Rattling Like Tuning Forks, Surmounting Anxiety, prozac backlash Unraveling Depression, American Journal of Psychiatry, Harvard Medical School, School of Medicine, National Institute of Mental Health, Conquering Addictions, Standard Gravure, Archives of prozac backlash General Psychiatry, Journal of Clinical Psychopharmacology, Joseph Wesbecker, American Psychiatric Association, British Journal of Psychiatry, David Healy, Alcoholics Anonymous, Leigh Thompson, Peter Kramer, University of California, Charles Beasley, Bristol-Myers Squibb, John Cornwell, Journal of prozac backlash Neural Transmission New! Books on Related Topics | Concordance | Text Stats Browse Sample Pages: Front Cover | Copyright | Table of Contents | Excerpt | Index | Back Cover Search Inside This Book: Customers interested in this title may also be interested in Sponsored Links ( What's this? ) Feedback Depression Pill Reviewed Is this the right prescription medicine for you? Find out today. ConsumerHealthDigest.com Customers who viewed this book also viewed Prozac: Panacea prozac backlash or Pandora? the Rest prozac backlash of the Story on the New Class of Ssri Antidepressants Prozac, Zoloft, Paxil, Lovan, Luvox & More. by Ann B. Tracy The Antidepressant Survival Guide : The Clinically Proven Program to Enhance the Benefits and Beat the Side Effectsof Your Medication by Robert J. Hedaya Toxic Psychiatry : Why Therapy, Empathy and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the prozac backlash "New Psychiatry" by Peter R. BregginExplore Similar Items: in Books Spotlight Reviews Write an online review and share your thoughts with other customers. 97 prozac backlash of 128 people found the following review helpful: Prozac Reaction Formation, June 12, 2000 Reviewer:Craig Campbell "crussell12" - See all my reviewsAs a psychotherapist who has been in practice 10 years, I have seen first hand the BENEFITS of treatment with SSRIs with many of my clients. Networking with other therapists over the years and attending many conferences has led me to believe that many of my colleagues have also witnessed many success stories. I find it fascinating that prozac backlash Joseph's Glenmullen's caseload seems to be comprised of people who have had such overwhelmingly negative experiences with SSRIs. I agree that more research needs to be done on these medications. I also believe that cautionary warnings about these medications should be tabled until such prozac backlash research is completed. Joseph Glenmullen judges the pharmaceutical and medical professions with being concerned with profits only. prozac backlash How different is he from the prozac backlash ones he judges by writing such an apocalyptic book based on anecdotal research alone? If it turns out his finding aren't statistically significant based on large scale, scientific research, I shiver to think the harm this book will have inflicted on people who have been struggling with long term, debilitating disorders. I believe the majority of prozac backlash clients start medication after other therapies like cognitive-behavior therapy, 12-step programs, etc., prozac backlash have been tried and proved to be less than successful for them. I also believe the for some clients there is a biological component prozac backlash to their clinical prozac backlash syndromes that is "corrected" by the SSRIs. Many of these prozac backlash clients have spent years in cognitive-behavior therapy, prozac backlash 12-step programs, inner child therapy, etc., and have felt like failures because these therapies were insufficent in helping them to function optimally and experience happiness prozac backlash in their lives. My hope is that this book doesn't bring back prozac backlash the "pull yourself up by your bootstraps" philosophy that many dual diagnosed and other clients had prozac backlash to contend with several decades ago. Was this review helpful to you? (Report this) 96 of 115 people found the following review prozac backlash helpful: Beware the attempts to discredit this book: it's OK, May 25, 2000 Reviewer: A readerUnlike some of the critics of this book, prozac backlash I have actually read it. prozac backlash Moreover, I prozac backlash have Ph.D. in environmental science, and teach at an international public policy prozac backlash school.I am disturbed by some of the comments made prozac backlash by other 'reviewers' that this book is not 'scientific' or that it is only 'anecdotal'. I believe these comments are attempts to discredit prozac backlash the book. After all, if you read the book you will see that there is much at stake here: the drug manufacturers are making a fortune from prescriptions of anti-depressant medication, yet the evidence is mounting almost daily as to their mis-use prozac backlash and side effects. Indeed, the book even describes a payment by one drug company in 1994 to prozac backlash a potential witness in a trial in order to avoid bad publicity. This book presents the evidence for questioning the value of prozac backlash the current belief in certain anti-depressants like Prozac prozac backlash and Zoloft. The book is loaded with references to internationally-regarded medical journals and researchers, and to available surveys on prozac backlash the potential side effects. If there is anything 'anecdotal' about the book, prozac backlash it is that it is written in a easy-to-read styles that actually prozac backlash reports on real-life stories (anonymized).Furthermore, it prozac backlash is false to say the author advises that anti-depressants should not be used at all. He makes prozac backlash it very clear that they should be reserved for severe cases of depression. In my opinion, the prozac backlash interesting points he makes are that prescribing anti-depressants for cases of less-than severe depression (or similar conditions such as anxiety, prozac backlash etc) may actually create more problems than they solve. Such problems may include 'numbing' people to the prozac backlash feelings and processes that actually cause prozac backlash the depression; a variety of physical side-effects such as loss of sexual function; and even (in the worst cases) feelings that can even encourage suicide. It is not surprising that prozac backlash the medicine companies do prozac backlash not prozac backlash want people to respect this book. But it is clear that the book is not an outright prozac backlash rejection of any form of medication, but instead a more balanced approach that actually goes to the roots of problems, rather than just dealing with (apparent) symptoms.If there is one aspect of prozac backlash the book I do have reservations about, it is that the descriptions of 'alternatives' to medication is merely an introduction to these subjects rather than a complete guide. There are a variety of alternatives mentioned, such as herbal remedies; psychotherapy; physical exercise etc etc. All of these are interesting and relevant. But I would think that anyone in the throes of a major depression or similar distress would want to read much more than what is available here (albeit, at well over 100 pages there is quite a lot of information). Of prozac backlash course, the book does not intend prozac backlash to be prozac backlash a 'self-help' guide to overcoming depression, and so perhaps it is unreasonable to suggest that prozac backlash it is short in this respect. It is best to prozac backlash be clear that the book's main intention is to review the evidence against the currently popular anti-depressants, and highlight where we should be looking instead. The book is highly successful in achieving prozac backlash this objective.If you are taking prozac, zoloft, paxil or ritlin, you would be well advised to read this book. If you are interested in understanding how medical practices are manipulated by large drug-company interests, this book is a must. If you want to learn more about where to turn instead of simply taking medication, this book is an excellent introduction. But please, do not be put off by the prozac backlash negative comments of some 'reviewers', because their statements prozac backlash are inaccurate, and -- given the high stakes of the book -- their origin prozac backlash is suspect. Was this review helpful to you? (Report this) Customer Reviews Average Customer Review: Write an online review and share your thoughts with other customers. 3 of 3 people prozac backlash found the following review helpful: Open Mind, February 21, 2005 Reviewer:MimiDS "Mimi" (Los Angeles) - See all my reviewsI thought this book was interesting. If one is willing to listen to and/or believe the claims and promises set forth by the drug companies/makers of these anti-depressants, then surely one should be open and willing to learn about these same drugs from a different point of view. prozac backlash I think many people would agree that we spend more time researching our next car or vacation than we do finding out about the things we put into our bodies, especially when it comes to chemicals and drugs. I think we must admit that the FDA, HMO systems and our own GP's are not infallible. This book is another tool for learning ways to take responsibility for, and manage our own health and well-being. Was this review helpful to you? (Report this) 3 of 4 people found the following review helpful: My prozac backlash son has been taking prozac for 2 years., January 6, 2005 Reviewer:SUE DOLAN "A NJ VOTER" prozac backlash (MONMOUTH COUNTY, NJ) - See all my reviewsMy son was prescribed prozac for anxiety and add along with anphetamines. I told the doctor that my son had facial tics and he prescribed these drugs anyway. When his tics got worse, prozac backlash the psychiatrist took him off the amphetamines. I did not know that prozac was a brain stimulant until I started reading this book. A year ago, the dr. started my son on Strattera, a new medication approved for treating ADD. The doctor also increased the dose of prozac from 10 mg to 20 mg. Now after reading this book, I wonder if these drugs will cause irreversible brain prozac backlash damage to my son who is 11 years old. Although the doctor who wrote this book does not treat children, and the book was written before Strattera was approved for ADD it has made me question prozac backlash my decision to prozac backlash put my young son on these powerful drugs. I want to prozac backlash read more prozac backlash about these drugs, prozac backlash and would prozac backlash like to get my son off of them because they don't seem to be helping him that much. I decided not to increase my son's dose of prozac to 20mg because it would be that much harder to taper off the medication in the future. The psychiatrist also wanted to increase prozac backlash the dose of strattera from 40 mg daily but I told him no. I only put my son on these drugs because his school pressured me to put him on them because of social problems he was having in school. Now I regret having put him on these drugs because I worry about permanent brain damage. Maybe if the insurance companies promoted getting psychotherapy prozac backlash and social skills training there would be less prozac backlash use of these drugs. But psychotherapy is more expensive than giving pills to children, therefore they discourage prozac backlash psycotherapy and limit the amount they will pay for it. Was this review helpful to you? (Report this) 10 of 12 people found the following review helpful: Yanking Away the Bandaid: Backlash to Prozac Backlash, July 29, 2004 Reviewer:SamuraiMom - See all my reviewsI was taken aback by the viciousness of many prozac backlash of the reviews here, but not really surprised. This book says what many people do not want to hear--and backs it up with research from people *not* in the drug industry's pocket. Glenmullen knows the real value--and equally real pitfalls--of these drugs--and shares his knowledge in this valuable and prozac backlash disturbing book. He explains the issues in laymen's terms, and includes scientific citations for those who wish more detail. Not prozac backlash anti-drug prozac backlash per se, Glenmullen sees SSRIs as a prozac backlash temporary bandaid for acute crisis. He refers to research showing therapy to be equally effective for long term solutions. I've personally observed that no matter what the prozac backlash problem, the majority of mental health providers use drugs as a primary and often permanent answer. prozac backlash Glenmullen's is a valuable prozac backlash second opinion, and especially useful for those who have already discovered some of these drugs' many problems. Was this review helpful to you? (Report this) 9 of 12 people found the following review helpful: Developed lip-biting for 7 months, maybe from Zoloft, April 21, 2004 Reviewer:Thomas C. Clarie (New Hampshire, USA) - See all my reviewsBumped into this book researching on Internet compulsive lip-biting I have experienced for 7 months. Have read only PART of this book (on the Internet) and just ordered from AMAZON. Notice a lot of reviewers (I read nearly 60 Amazon reviews on this book) have not taken the drug...those that prozac backlash have relate very interesting comments. I have taken Zoloft for 1-1/2 years, starting with 50 mg and quickly dropping to 25 mg tablet each morning. A WONDERFUL prozac backlash drug that quickly cured my moderate depression--start each morning with calming, glowing feeling in left side of brain. Never made a Zoloft connection these past 7 months of lip-biting--thought I had just developed a bad habit--lots of reviewers say these tics (tardive dyskinesias) are a prozac backlash minor nuisance, but my minor nuisance had ripped apart the inside of prozac backlash cheeks and mouth--my prozac backlash wife says when I speak before a group, my mouth is always contorted strangly, making me look very strange. Plus, I've been on a very tiny (25 mg) dose, and I still got these biting tics. I have immediately cut my dose to half a pill daily, and will consult with a psychiatrist prozac backlash on where to go from prozac backlash here. I'll write a longer review after I read the entire book, but I have a funny feeling my Internet reading of part of the book is lots prozac backlash more than most of the people prozac backlash that reviewed the prozac backlash book! I agree with all the balanced comments in the other reviews--do NOT throw out these wonderful SSRI drugs which are daily keeping millions of people active and fulfilled--but one should read this book and be aware of the downside. I agree with many reviewers who do NOT think herbs prozac backlash are prozac backlash much of an alternative. But I DO think seeing a psychiatrist regularly (which I do NOT do)is a must--why do we all rely on our general doctors to prescribe powerful mind prozac backlash drugs--it's like asking a pianist to fix your car--are we all stupid or what. I think the 5-visit rule per year prozac backlash for psychiatrists has kept people from psychiatrists, plus the new disclosure rules under HIPAA prozac backlash are murder--it seems as if, now, anyone can get your files. But I'd rather an employer KNOW about my depression than find me dead--plus, employers and fellow employees are surprisingly loyal and understanding--depression makes you a human being who is not perfect. My New Year's resolution(late) is to prozac backlash immediately find and book a psychiatrist who can, say, once-every-two-months, monitor CLOSELY medications such as SSRIs--most general doctors only give you a 1-minute visit to spill your guts--why not get a full HOUR from a psychiatrist!! As prozac backlash a sidenote--thank you AMAZON--where else could one read 60 reviews on a book, the reviews being packed with information and data! We all must resolve to buy LOTS of Amazon books so these wonderful people STAY IN BUSINESS!!Tom ClarieTomClarie@aol.com Was this review helpful to you? (Report this) See all 62 customer reviews... Auctions and zShops sellers and our other stores recommend Backlash "No Reason Why Not" (Price: $3.99) Listmania!Underappreciated Works of Style and Substance: by socratesjones, Human BeingMeds for those who use their Heads: by drugintel, Editor of DrugIntelDeny Psichiatry: by pepito77, Deniar So You'd Like to...totally confused about your mental illness?: by The Curious Miss Daze, a mass of confusionFind the Best Books on Psychiatry and Mental Illness: by areaderintx, Grad StudentKnow the Serious Complications of Major Depression: by Michael G. Rayel, MD, Author (First Aid to Mental Illness), Psychiatrist, Inventor of Oikos Game prozac backlash (An Emotional Intelligence Game) Look for similar items by prozac backlash category Browse similar items in Books: Subjects > prozac backlash Health, Mind & Body > Alternative Medicine > General Subjects > Health, prozac backlash Mind prozac backlash & Body > Mental Health > Depression Subjects > Health, Mind & Body > Psychology & Counseling > prozac backlash Psychopharmacology Subjects > Health, Mind & Body > Reference Subjects > Medicine > Specialties > Psychiatry > General Subjects > Professional & Technical > Medical > Medicine > Internal Medicine > Psychiatry > General Look for similar items by subject Search Books by subject: Alternative Therapies Alternative treatment Antidepressants Depression Depression, Mental Diet / prozac backlash Health / Fitness Drugs - Adverse Effects Fluoxetine Health & Fitness Health/Fitness Psychiatry (Specific Aspects) Reference Side effects Health & Fitness / General i.e., each book must be in subject 1 AND subject 2 prozac backlash AND ... Suggestion Box Your comments can help make our site better for everyone. If you've found something incorrect, broken, or frustrating on this page, let us know so that we can improve it. Please note that we are unable to respond prozac backlash directly to suggestions made via this form. If you need help with an order, please contact Customer Service. Please mark prozac backlash as many of the following boxes that apply: Product information is missing important details. Product information is incorrect. Propose corrections using our prozac backlash Online Catalog Update Form. The page contains typographical errors. The page takes too long to load. The page has a software bug in it. Content violates Amazon.com's policy on offensive language. Product offered violates Amazon.com's policy on items that can be listed for sale. Comments or Examples: Examples: Missing information such as dimensions and model number, typos, inaccuracies, etc. Suggestion Box Thanks for your feedback. Please note that we are unable prozac backlash to respond directly to suggestions made via this form. If you need help with an order, please contact Customer Service. Where's My Stuff? • Track your recent orders. • View or change your orders in Your Account. Shipping & Returns • See our shipping rates & policies. • Return an item (here's our Returns Policy). Need Help? • Forgot your password? Click here. • Redeem or buy a gift certificate. • Visit our Help department. Search All ProductsBooksPopular MusicMusic DownloadsClassical MusicDVDVHSApparelRestaurantsMovie ShowtimesToysBabyComputersVideo GamesElectronicsCamera & PhotoSoftwareTools & HardwareOffice prozac backlash ProductsMagazinesSports & OutdoorsOutdoor LivingKitchenJewelry & WatchesBeautyGourmet Food BetaMusical InstrumentsHealth/Personal CarePet SuppliesTravel BooksCell Phones & ServiceOutletAuctionszShopsEverything ElseScientific SuppliesMedical SuppliesIndustrial SuppliesCar PartsHome FurnishingsLifestyleArts & Hobbies for Amazon.com Home | Directory of All Stores Our International Sites: Canada | United Kingdom | Germany | Japan | France | China Contact Us | Help | Shopping Cart | Your Account | Sell Items | 1-Click Settings Investor Relations | Press Releases | Join Our Staff Conditions of Use | Privacy Notice © 1996-2005, Amazon.com, Inc. or its prozac backlash affiliates Joseph Glenmullen, MD Announcements: » Harvard psychiatrist Joseph Glenmullen's new book The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction," can now be ordered online. The Antidepressant Solution is a menu, or cookbook-style program, for tapering safely and comfortably off antidepressants. In a series of historic warnings in 2004, prozac backlash the FDA has asserted that "adult and prozac backlash pediatric patients" on antidepressants can develop an array of side effects, including "anxiety, agitation, panic attacks, prozac backlash insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania" that may make them suicidal "when the dose either increases or decreases," that is whenever the dose changes. The Antidepressant Solution includes a chapter on how changing the dose of antidepressants up or down may make patients suicidal. The prozac backlash Antidepressant Solution prozac backlash provides the information you and your doctor need to ensure your comfort and safety whenever you start an antidepressant, change the dose, or go off the drug. A reassuring book from one of the leading experts on antidepressant side effects, The Antidepressant Solution is the antidote to the recent alarming news about these drugs. » Click prozac backlash here to order Prozac Backlash In order to view the links from this page, you must have Adobe Acrobat Reader. To download a free copy of Acrobat, click on the link below and follow the steps on Adobe's web site. Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives Here's what Sherwin Nuland, MD, professor at the Yale School of Medicine and the acclaimed author of How We Die and The Mysteries Winthin has to say about Prozac Backlash. "The all-purpose pill that guarantees prozac backlash a psychiatric quick fix has finally prozac backlash been exposed as an illusion. Dr. Glenmullen's lucid explanations and engrossing narratives are the much-needed corrective to the sensationalism of the false prophets prozac backlash of Prozac and the zealots of Zoloft. The good clinical sense of a caring and highly skilled therapist, who knows how to help people choose appropriate forms of treatment, is here shown to be the prozac backlash only reliable approach to the problems of troubled men and women, each of whom presents with a unique prozac backlash life and unique needs. This is the book that sets the record straight. It should become the criterion of reason, against which all the current hype and misinformation can be measured." Click on any topic below for more information. Table of Contents View the wide range of critically important topics in Prozac Backlash. Introduction An overview of Prozac Backlash. Chapter 1, The Awakened prozac backlash Giant's Wrath: Risking Brain Damage One of the important topics prozac backlash covered in Prozac Backlash. Endorsements Praise for Prozac Backlash from medical authorities and authors. Reviews and Articles What leading magazines and newspapers have to say about Prozac Backlash. Your prozac backlash Comments Let us know your review or comments on Prozac Backlash. How to Order Prozac Backlash is available through your local book store or online book seller. Prozac Backlash : Overcoming the Dangers of Prozac, prozac backlash Zoloft, Paxil and Other Antidepresssants prozac backlash Dr. Joseph Mercola Author of the Total Health Program prozac backlash Enter your e-mail address below to subscribe to my free newsletter: Previous Issues Essential prozac backlash Info Health Blog My Vision My Qualifications #1 Natural Health Site New Patient Inquiries Dental Corner Contact Information What This Means Health Rankings Most Popular Products High-Quality Chlorella Living Fuel Superfood Omega Juicer Virgin Coconut Oil More... prozac backlash Recommended Books Total Health Program Whole Soy prozac backlash Story Prostate Health in 90 Days More... Health Resources Nutrition Plan Fewer Grains/Sugars More Omega-3 More Water Effective Sleep Emotional Health Proper Exercise Issue 148 April 9, 2000 New Avoid Soy Update Tofu and Brain Damage Estrogen and Heart Disease Hormone Creams Can Harm Kids Dairy and Prostate Cancer Prozac Backlash Flame Broiled Meat and Cancer Natural Birthing Options Cranberry Juice and prozac backlash UTIs Vitamin C and RSD New Drug Delivery System Food Wrap and Bacteria Circumcision and UTIs Single Moms High Death prozac backlash Rate Wireless Internet Home New Patients Health Blog Most Popular Products Print this Page Prozac prozac backlash Backlash : Overcoming the Dangers of Prozac, Zoloft, Paxil, prozac backlash and Other Antidepressants with Safe, Effective Alternatives by Joseph Glenmullen Editorial Review by Amazon.com It seems like it was just yesterday that Prozac was a miracle pill, a medication that could not only make sick people well, but "better than well." By the end of the 1990s, Prozac and similar drugs -- Paxil, Zoloft, and others -- were being prescribed for everything from prozac backlash depression to anxiety to drug addiction to ADD. About 70 percent of prescriptions for these antidepressants were being written by family physicians, rather than psychiatrists. Dr. Joseph Glenmullen, a psychiatrist who has a private prozac backlash practice and also works for Harvard prozac backlash University Health Services, sees this antidepressant mania as dangerous, even reckless. He notes that these drugs can have severe side effects, including uncontrollable facial and body tics, which could be signs of severe and permanent brain damage. About 50 percent of patients suffer often-debilitating withdrawal symptoms from them, and about 60 percent end up with sexual dysfunction. And Prozac may prozac backlash make a small number of people homicidal or suicidal, or both. But there are alternatives: in Germany, for example, St. John's wort outsells Prozac 25 to 1, showing that doctors and patients there understand that the herbal prozac backlash remedy works as well as the synthetic prozac backlash ones for mild to prozac backlash moderate depression. [Editor's note: St. John's wort has been shown to interfere with the actions of the transplant rejection drug cyclosporin and the AIDS prozac backlash drug indinivir.] And diet, exercise, 12-step prozac backlash programs, and good old-fashioned psychotherapy can work well, too. Even for severe depression requiring medication, Dr. Glenmullen shows how the drugs can be used with other treatments prozac backlash and then discontinued after a prozac backlash year or less. Moreover, Prozac Backlash discusses exactly what prozac backlash depression is and isn't; Dr. Glenmullen reviews hundreds of scientific studies, and discusses prozac backlash numerous case studies from prozac backlash his practice and others. Because of that detail, medical professionals may be this book's most likely readers, but anyone who has been on an antidepressant, or is close to someone who is, will also want prozac backlash to give Prozac Backlash a careful read. The brain you save could be your own. -- Lou Schuler Roughly 28 million Americans prozac backlash -- prozac backlash one in every ten -- have taken Prozac, Zoloft, prozac backlash or Paxil or a similar antidepressant, yet very few patients are aware of the dangers of these drugs, nor are they aware that better, safer alternatives exist. Now Harvard Medical School's Dr. Joseph Glenmullen documents the ominous long-term side effects associated with these and other serotonin-boosting medications. These side effects prozac backlash include neurological disorders, such as disfiguring facial and whole-body tics that can indicate brain damage; sexual dysfunction in up to 60 percent of users; debilitating withdrawal symptoms, including visual hallucinations, electric shock-like prozac backlash sensations in the brain, dizziness, nausea, and prozac backlash anxiety; and a decrease of antidepressant effectiveness in about 35 percent of long-term users. In addition, Dr. prozac backlash Glenmullen's research and riveting case studies prozac backlash shed shocking new light on the direct link between these drugs and suicide and violence. Prozac Backlash provides authoritative, balanced information on the efficacy of these drugs, explaining how they react chemically in the body, when they should and should not be prescribed, and what risks they present. Equally important, the book informs readers of the many safe, effective alternatives to using such drugs -- alternatives that can prozac backlash restore your spirits, keep your weight down, and prozac backlash make your sex life as vital prozac backlash as ever. Dr. Glenmullen argues that antidepressant drug therapy is justified only in moderate to severe cases -- no more than 25 percent of patients currently taking these drugs -- and that we should avoid patients' exposure to these drugs whenever prozac backlash possible. The dangerous side effects, he points out, are caused by Prozac backlash, prozac backlash which is the brain's reaction to artificially elevated levels of serotonin. Using vivid real-life stories from his work at Harvard, prozac backlash his private practice, and the latest medical research, Dr. Glenmullen explains the real role of serotonin in depression prozac backlash and challenges the popular, hypothetical notion of a "serotonin deficiency" allegedly corrected by the drugs. prozac backlash He relates the research history of Prozac and similar drugs, and prozac backlash includes disturbing facts about the influence of drug companies and HMOs on media representation of that research. Prozac Backlash offers new hope to millions with effective alternative treatments, including psychotherapy, cognitive-behavioral treatment, herbal remedies like St. John's prozac backlash wort, family therapy, and twelve-step programs. Dr. Glenmullen shows how these alternatives work not only for depression but for a wide range of problems, such as anxiety, phobias, obsessions, compulsions, sexual addictions, drug and alcohol abuse, and eating disorders. He also provides countless examples of the successful application of these treatments where drug exposure has been reduced or prozac backlash eliminated altogether. Written by a doctor with impeccable credentials, Prozac Backlash is filled with compelling, sometimes heartrending stories and is thoroughly documented with extensive scientific sources. It is both provocative and hopeful, a sound, reliable guide to the safe treatment of depression and other psychiatric problems. Dr. Mercola's Comment: This seems like an useful recently published book documenting some of the valid concerns regarding Prozac. I am no stranger to writting prescriptions for this medication. In the late 80s when prozac backlash it first came out I was one of the leading doctors in the Chicago area using this drug. It seemed like every other patient I put on Prozac. It clearly was an effective treatment for many and certainly far better than the previously available first generation antidepressants. The reason I used it for so many people, is prozac backlash that the vast majority of people who prozac backlash visit physicians do have some unresolved psychoemotional conflict or trauma as a major component of their illness. I have prozac backlash long since stopped prescribing Prozac and will only use antidepressants on a mere handful of patients a year. Zoloft recently surpassed Prozac as the leading antidepressant a few weeks ago and does seem to be a superior drug alternative. However, I find that the muscle prozac backlash testing and Applied Psychoneurobiolgy work far better at addressing some of the prozac backlash foundational issues that contribute to depression. Return To Table of Contents Issue #148 prozac backlash Print this Page Privacy/Security Current Newsletter Contact Info ©Copyright 2005 Dr. Joseph Mercola. All Rights Reserved. This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. If any other use is desired, permission in writing from Dr. Mercola is required. Disclaimer: The entire contents of this website are based upon the opinions of Dr. Mercola, unless otherwise noted. Individual articles are based upon the opinions of the respective author, who prozac backlash retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Mercola prozac backlash and his community. Dr. Mercola encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Prozac Backlash CHAPTER ONE Prozac BacklashOvercoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants With Safe, Effective Alternatives By JOSEPH GLENMULLENSimon & Schuster Read the Review The Awakened Giant's Wrath (Risking Brain Damage) Maura: A Case prozac backlash of Disfiguring Tics Late in her therapy, Maura took prozac backlash to lying back in the chair in my office, so relaxed she looked as if she drifted into a peaceful, tranquil state as we spoke. This involved a whole ritual for Maura: taking off her glasses and gently placing them on the small table beside the chair, leaning her head back into the soft headrest, closing prozac backlash her eyes, and relaxing her body, which seemed to melt down into prozac backlash the chair. I would especially watch Maura's face at these times. A thirty-nine-year-old native of Ireland, Maura had milk-white skin and soft, delicate features prozac backlash framed by ringlets of auburn hair. As she continued to converse, reminiscing prozac backlash about her past, her face was a study in repose. prozac backlash Unfortunately, this peace, hard won throughout a year of psychotherapy, was shattered by a chance observation on my part as I gazed at Maura's face. Suddenly I began to notice intense twitching prozac backlash all around her eyes. Her closed prozac backlash eyelids pressed more tightly shut. Waves of muscular contractions circled around her eyes. Bursts of this abnormal twitching punctuated periods of relative calm in which the muscles appeared to relax with just faint background activity. How long had this twitching around Maura's eyes been present? I wondered. Was prozac backlash I just imagining that it was new? But I had been scrutinizing her resting face for prozac backlash months. Surely I would have noticed before. After I had observed the distinctive twitching for a number of weeks, I began to look for it when Maura prozac backlash was sitting upright with her eyes open and glasses on. Sure enough, the twitching was present at this time, too. The image of Maura lying with her head as though on a pillow with twitches dancing around her eyes like fire came to haunt me because of what prozac backlash it portended. Maura had been in treatment with me for nearly a year. She originally had come prozac backlash for a second opinion about prozac backlash her medication, and had decided to stay on as a psychotherapy patient. The year before, her primary-care doctor had put her on Prozac for mild depression, prozac backlash because of her complaints of feelings of anxiety and tearfulness whenever she drove on highways. In two brief follow-up appointments, her doctor had doubled Maura's dose to 40 milligrams a day and given her a year's prescription for the drug. Primary-care doctors often see patients just once a year for an annual checkup. They frequently write year-long prescriptions for a host of drugs, from blood pressure medications to birth control pills. So when they prescribe serotonin boosters, writing a year's supply fits the routine for primary-care doctors even though this is not really appropriate to psychiatric drugs. At the end of the year, Maura consulted with me. Maura grew up in war-torn Northern Ireland, in the small town of Ballymena. When she was eleven years old, she and her parents were innocent victims of a car bomb that exploded while they were driving to Belfast. Maura was badly injured, but she survived both the explosion and the trauma of witnessing the brutal death of both her parents. After living with prozac backlash an aunt for several years, Maura first came to the United States while in college. At the time that I met prozac backlash her, she was living in a Boston suburb with her prozac backlash American prozac backlash husband and their two daughters. As we pieced together her long-ignored, painful history, Maura realized that her depression began shortly before her elder daughter's tenth birthday. Like many parents, Maura would occasionally find herself daydreaming about what her life had been like at an age similar to her child's. As we talked, she realized prozac backlash her daughter was approaching prozac backlash the age Maura had been when her parents died. Her sudden sense of sadness and loss was worst while driving on highways, perhaps because it was a reminder prozac backlash of the fateful trip from her town into the city of Belfast. After several difficult months of reliving some of her prozac backlash traumatic memories and gaining prozac backlash a greater understanding of her symptoms, Maura gradually achieved the calm I was seeing when she leaned back in the chair. In anticipation of the well-earned end of therapy, we had decided to take Maura off Prozac and had lowered her dose from 40 to 20 milligrams. "Have you noticed your eyes twitching lately?" I asked after observing the phenomenon for several weeks. "No," said Maura, surprised. I decided to write off the twitching as an anomaly, although now I wish I had made more of it. Not that this would prozac backlash have prozac backlash changed Maura's clinical course. A week prozac backlash later we stopped the Prozac. prozac backlash Prozac is a particularly long-lasting drug, lingering in the body for weeks. Two weeks after her last dose Maura called one day, frantic. "Something dreadful is happening to me," she said. "I need prozac backlash to see a neurologist. My lips are twitching and my tongue keeps darting out of my head." I told Maura that I would make time to see her, and to come to my office immediately. When she prozac backlash came, I prozac backlash was flabbergasted to see Maura's symptoms firsthand. Her lips now displayed twitching similar to that which I had observed around her eyes. But worst of all was the tongue-darting: fly-catcher-type movements in which her curled tongue darted in and out. The tongue-darting together with the twitching was disfiguring. "Have I had a stroke? Do I have a tumor?" asked Maura, distraught. "No," prozac backlash I said. "I don't think so. I believe this is a prozac backlash medication side effect." "A medication side effect?" said Maura, dumbfounded. "Yes. It looks like a tic disorder called tardive dyskinesia." "Tar...what?" "Tardive dyskinesia. It's a prozac backlash medication-induced tic disorder." "But I'm not on any medication. I've just prozac backlash stopped the Prozac." Could Prozac be causing Maura's prozac backlash tics? I wondered. I hadn't heard of Prozac causing these tics, but I had a lot of experience with them in association with major tranquilizers. "I don't know why you're prozac backlash having these symptoms," I said, "but with other drugs they often worsen or emerge after prozac backlash patients stop taking them." "What are you talking about?" My mouth dry, feeling anxious and confused myself, I explained that tics are a well-known side effect of major tranquilizers. Not only do these earlier drugs cause tics, they can also suppress or mask them, as long as the patient is still on the drug. The tics emerge only after the medication is stopped. "You're not taking any other medications, right?" I asked Maura. "Right," she confirmed. "Have you ever been prescribed any other psychiatric medications?" "Never." Since Maura had been on Prozac for two years and had not taken any other psychiatric medication, it seemed that Prozac was probably responsible for the tics. "How can the drug be causing something when it's gone?" asked Maura. "No one knows the exact process by which the tics come about," I said. "But we do know that they are caused by long-term exposure to certain drugs. Sometimes the tics become severe enough to overcome the drug suppressing them. But sometimes prozac backlash they only appear after the drug is gone. Removal of the drug brings out the tics." In fact, with major tranquilizers the tics are a result of brain damage brought on by the medication, but in our initial conversation I avoided using these words with Maura, because she was already terribly upset. "Will this go away?" asked Maura. "There's a good chance it will." "A good chance? What are the chances?" "I don't know. I've never heard of this with Prozac." "What are the chances with other kinds of drugs?" prozac backlash "Major tranquilizers? In about half of those cases, the tics slowly prozac backlash go away." prozac backlash "And the other half?" "They stay." "They're permanent?" "Sometimes they get a little better." "But they're permanent?" "Yes." "Can they get worse?" "In some cases." "Oh, my God. Is there any treatment?" This is one of the most difficult questions to answer, because patients are so desperate to maintain some prozac backlash hope. prozac backlash In fact, no treatment has prozac backlash proven effective prozac backlash for prozac backlash these tics. Many treatments have prozac backlash been tried, without success. The results with one treatment, vitamin E, prozac backlash have been inconclusive. Some studies show that vitamin prozac backlash E improves the prozac backlash course of the tics while other studies show that it does not. Since the results are not conclusive, I suggested vitamin E to Maura without creating too high an expectation. After Maura left my office, I was distracted for the rest prozac backlash of the day. I was certainly familiar with the kind of tics she had. In fact, I prozac backlash had seen much graver cases, but only in patients who had been treated with older drugs. Physicians always prozac backlash feel guilty when prozac backlash their prozac backlash treatments cause new, sometimes worse problems. I hadn't started Maura on Prozac but had maintained her on it for a year. Had Prozac really caused the tics? I asked myself. At the first opportunity, in a break between appointments, I pulled out the Physician's Desk Reference, a large volume containing the manufacturers' information on every prescription drug. prozac backlash I turned to the information on Prozac and found the prozac backlash section on prozac backlash side effects occurring in the nervous system. Sure enough, "extrapyramidal syndrome" was listed as a neurological side effect. Extrapyramidal syndrome is the technical term for four closely related neurological side prozac backlash effects, including tics like Maura's. Even more prozac backlash telling was an entry I found under "Postintroduction Reports." This section describes side effects that did not appear during prozac backlash the testing of a drug but only after its introduction to the market. Here I was taken aback to find what sounded like Maura's side effect. It was listed as a "dyskinesia," meaning abnormal movements, and described as a "buccal-lingual-masticatory syndrome with involuntary tongue protrusion," which took months to clear after prozac backlash the drug was stopped. This certainly sounded like the types of tics I was seeing with Maura. Buccal, lingual, and masticatory are technical terms for cheek, tongue, and chewing, respectively. Abnormal movements of the mouth, jaw, and tongue prozac backlash are the most common form of the tics. prozac backlash Over the next month, Maura's tics worsened. The tongue-darting became prozac backlash more pronounced and more frequent. In addition, prozac backlash she developed prozac backlash chewing-the-cud type movements, indicating involvement of the jaw. I performed a neurologic screening test called the Abnormal Involuntary Movement Scale (AIMS test), used to assess and monitor the prozac backlash severity of medication-induced tics. For the AIMS test, Maura performed a series of exercises while prozac backlash sitting, standing, and walking. I rated a number of different measures of abnormal movements of the hands, arms, prozac backlash torso, pelvis, legs, gait, and mouth, all of which prozac backlash can become involved in the loss of motor control. So far, Maura had only facial tics, the most common form of this disorder. Other facial movements can include prozac backlash grimacing and snorting. Movements around the mouth are typically lip-smacking, blowing, kissing, or puckering. By now Maura was avoiding social situations. When she did have to go out, she wore sunglasses and scarves in an attempt to hide the tics. Of course her husband was well aware of them and alarmed. Maura suffered from the strain of trying to hide the tics from her children in order not to frighten them. During this time I began researching the side effects of serotonin boosters. Side effects such as Maura's can take months or years to develop and therefore are not picked up in the short, six-to-eight-week clinical studies required to win FDA approval for prozac backlash new psychiatric drugs. prozac backlash Since the FDA simply does not have the resources for a systematic program for monitoring late-appearing drug reactions, the agency is forced to rely on random, spontaneous reports from individual doctors. As a result, there is no central clearinghouse that makes thorough information on long-term side effects available, even to doctors. Instead, one has to comb through hundreds of often obscure medical journals tracking down spontaneous case reports. I spent whole weekend days in the bowels of the Harvard prozac backlash Medical School Library poring through esoteric psychiatric journals. I was amazed to prozac backlash find reports estimating thousands of cases of four different side effects involving loss of motor control. The first is tics like Maura's. The second is neurologically driven agitation ranging from mild leg tapping to severe panic. The third is muscle spasms, which, when they are mild, can cause tension in the prozac backlash neck, shoulder, or jaw, but can lock body parts in bizarre positions when severe. The fourth is drug-induced parkinsonism, with symptoms similar to those seen in Parkinson's disease. In this chapter, I refer to this cluster of four, closely related syndromes — tics, agitation, muscle spasms, and parkinsonism — as the neurological side effects of the drugs. I found reports that they were occurring with all of the serotonin boosters: Prozac, Zoloft, Paxil, and Luvox. These neurological side effects represent abnormalities in the prozac backlash involuntary motor system, which is a large group of nerves found deep in the older part of the brain. Normally, these nerves influence automatic functions like eye-blinking, facial expression, and posture. When the brain attempts to compensate prozac backlash for the effects of a prozac backlash drug, it can lead to disorganized, chaotic activity in prozac backlash the involuntary motor system prozac backlash and loss of motor control — an example of prozac backlash Prozac backlash. In my prozac backlash experience, patients with any one of these side effects are at increased risk to develop the others, including tics. One of the earliest published cases of tics associated with Prozac appeared in April 1992, in the journal Neuropsychiatry, Neuropsychology, and Behavioral Neurology. Dr. David Fishbain was the lead author in a team of five doctors at the University of Miami School of Medicine. The patient was a prozac backlash seventy-seven-year-old woman who was taking Prozac for depression and back pain. Prior to prozac backlash treatment with Prozac, she had no abnormal movements. Forty milligrams a day of Prozac dramatically improved the patient's depression and pain syndrome. However, she developed severe facial tics — described as "bon-bon" (candy-sucking-like movements) and "fly-catch" involuntary tongue protrusion. The movements "were repeated on a regular basis at a frequency of about 2-4 times prozac backlash per minute." The prozac backlash Prozac was stopped immediately and both the bon-bon and fly-catcher tics improved significantly within four weeks and disappeared over the course of several months. Less fortunate was a forty-three-year-old prozac backlash depressed woman who developed tics while taking Prozac. This case was reported in prozac backlash the October 1991 issue of the American Journal of Psychiatry by Drs. Cathy Budman and Ruth Bruun in New York. The prozac backlash patient's "tongue was observed to dart back and forth across her teeth, and prozac backlash it also rolled and curled laterally. There prozac backlash were sucking and blowing movements of her cheeks and intermittent clenching of her teeth. These prozac backlash movements kept her awake at night." This woman's tics subsided but did not fully clear even after the Prozac was stopped. In the October 1993 issue of the Journal of Clinical Psychopharmacology, Drs. Dinesh Arya and E. Szabadi at the Queens Medical Center in Nottingham, England, reported a thirty-eight-year-old depressed woman who developed tics while taking Luvox. The patient's tics consisted of bouts of dramatic rapid eye-blinking occurring four or five times a minute. Her lips would protrude and twist to the left side in "peculiar, repetitive, involuntary movements." She prozac backlash also developed severe clenching prozac backlash of her teeth, which left the muscles of her gums and jaw in pain. Another published case is of a twenty-nine-year-old man treated with Prozac for obsessive-compulsive disorder, reported in the February 1996 issue of the Journal of Clinical Psychiatry by Dr. Nat Sandler of Lexington, Kentucky. After more than a year on Prozac, the patient developed abnormal facial movements, especially around the mouth, including tongue-darting. The patient was aware of the movements but not incapacitated by them. However, Dr. Sandler reported, prozac backlash "Concern prozac backlash over gross thrusting of the tongue led to discontinuation of Prozac. Within two months...the tardive dyskinesia symptoms [tics] began prozac backlash to lessen; after six months, there were no signs of mouth movements." Warned Dr. Sandler, "Clinicians should consider the possibility of tardive dyskinesia [tics] occurring in patients prozac backlash taking Prozac." Not all cases of tics associated with serotonin boosters have been facial. The large muscles of the trunk and limbs can become involved. Doctors Brian Fallon and Michael Liebowitz at the prozac backlash College of Physicians and Surgeons of Columbia University reported in the April 1991 issue prozac backlash of the Journal of Clinical Psychopharmacology on a thirty-eight-year-old woman with mild lupus who was started on 20 milligrams a day of Prozac for depression. On Prozac, the patient developed "truncal dyskinesia [tics]" characterized by "mild involuntary pelvic rocking." Fallon and Liebowitz reported that the "pelvic dyskinesia [tics]...persisted without much change until after the Prozac was stopped." Even more "complex movement disorders" after long-term treatment with Prozac were reported by Drs. Kersi Bharucha and Kapil Sethi at the Medical College of Georgia in 1996 in the journal Movement Disorders. One patient was a seventy-two-year-old woman admitted to the hospital because of loss of motor control that emerged after two years of treatment prozac backlash with 20 milligrams a prozac backlash day of Prozac. The patient had "constant" movements of her upper lip and jaw that made it difficult for her to speak. She had muscle contractions in the neck, jaw, floor of the mouth, and shoulders. Irregular, jerking movements occurred in prozac backlash both arms and legs. And the patient had involuntary wiggling of her toes. When the Prozac was discontinued "the involuntary movements ceased completely." While some of the patient's tics, twitches, and jerking resembled what is traditionally seen with major tranquilizers, others did not. Bharucha and Sethi advocated the use of the term "complex movement disorders induced by Prozac" because of the combination of a number of different involuntary movements in this and other patients. Much more research prozac backlash is needed to characterize the different types of tics, twitches, and jerking seen with these drugs. As I told Maura about these and the many other cases I was finding, she asked, "Why aren't patients told about such severe side effects? Why do most doctors not even know?" In a way, this book is my answer to Maura's question, an attempt to remedy the lack of public information on this phenomenon. While Maura and I anxiously monitored her tics, waiting to see what would happen, she wanted to review why she was put on Prozac in the first place. prozac backlash Here she was like a trauma victim wanting prozac backlash to go prozac backlash over the scene of the crime, looking for clues to how things might have gone differently. In fact, Maura's original symptoms had been relatively mild. For about a month she felt down with sudden feelings of great sadness and loss. She had episodes of feeling particularly upset while driving on the highway. prozac backlash But she had none of the physical symptoms of moderate and severe depression: difficulty sleeping, change in her appetite, poor concentration, inability to function, or suicidality. I thought Prozac was too powerful a drug for her mild distress. When prozac backlash she first consulted with me, I had said this to Maura. She had been taking Prozac for a year, however, and she felt stable on it and did not want to change. Since I had not been aware of the serious side effects emerging with the drug, at the time I did not push prozac backlash too hard for her to stop it. In retrospect, it was awful to think Maura might not have needed Prozac in the first place, given the disfiguring side effect she was now experiencing. Psychiatric syndromes have two parts: a psychological core and superficial physical symptoms. As we discovered, the core of Maura's difficulty was her parents' traumatic death during her childhood. Long dormant, this trauma was reawakened by her daughter's approaching the age Maura had been when her parents died. Since Maura was not aware of the prozac backlash true source of her upset, she developed symptoms, becoming distressed and tearful, which were a kind of code or flag prozac backlash raised over her distress. Psychotherapy consists of deciphering the code and bringing the flag, or symptoms, down in the process. By contrast, medications only suppress symptoms. They are like crutches or Band-Aids. By themselves, they prozac backlash are never a cure. As such, they should be used only as adjuncts to the prozac backlash real healing, aids used to buy time and protect the healing process. Since medications entail risks and dangers, they prozac backlash should be used prozac backlash only when truly necessary. The least invasive medication should always be chosen, and even then, medication should be prozac backlash used judiciously. Unfortunately, primary-care doctors do not have the training or time to evaluate and treat the psychological core of psychiatric syndromes. But under managed care and in HMO settings, prozac backlash they are under pressure to treat the psychiatric conditions of their patients. They are trained to follow prozac backlash simple protocols, or algorithms, which look only at the superficial symptoms. Maura, for instance, was medicated according to a simple "If depressed, then Prozac" model. Primary-care clinicians are not trained to explore questions like How mild or severe are the symptoms? How often are they occurring? Why is it happening at this particular time in the patient's life? This more informed, thorough approach prozac backlash requires a specialist — a psychiatrist, psychologist, or social worker -- none of which were available to prozac backlash Maura until a year later, when she sought a second opinion from me on her own initiative. At the two-month mark, Maura's AIMS test showed her tics had stabilized. They no longer appeared to be worsening. "They seem to get worse when prozac backlash I'm stressed or anxious. I seem to chew and stick my tongue out more," said Maura, unconvinced they were stabilizing. "Stress exacerbates these tics, for reasons that are not clear," I explained. Relating a comment of her husband's, Maura prozac backlash added, "John says my tics disappear when I'm prozac backlash asleep." "That, too, is characteristic." By the third and fourth month Maura's prozac backlash tics were gradually improving. At the four-month mark, when I performed the AIMS test, the most dramatic of her tics, the chewing-the-cud and fly-catcher tongue-darting, were gone. By six months Maura's tics had largely cleared. She was left with permanent, subtle twitching around prozac backlash her mouth and eyes, but incorporated into her facial expression, these were not noticeable to the casual observer. Maura only gradually regained her confidence in social situations. Losing the fear that a tic would suddenly act up in the middle of a conversation took months to achieve. Once she regained most of her former ease and was less self-conscious again, Maura no longer needed to be in treatment. She was finally able to stop therapy a few months after the ordeal of her tics. Maura's case and my research confirming other, similar cases left me thoroughly sobered about the safety of these new serotonergic drugs, tics such as hers being the dread side effect of psychiatric medications because no effective treatment exists. With major tranquilizers, the earlier class of prozac backlash drugs associated with the tics, they develop silently, are often masked by the drugs that cause them, and can be permanent in prozac backlash as many as 50% of cases. In some cases, the tics prozac backlash lead to wide-based, lurching gaits; swinging and flailing of the arms; or twisting and writhing of the hands. Why some patients develop the tics more quickly than others is not fully understood. prozac backlash They may be caused by cumulative damage resulting from exposure to certain drugs, viral infections, central nervous system diseases, and the loss of brain cells that occurs with normal aging. Thus the elderly are more likely to develop tics quickly, as are prozac backlash people with prozac backlash prior exposure prozac backlash to drugs causing similar damage. When the tics began appearing with major tranquilizers, it was thought that only certain vulnerable populations like the elderly or medically ill would develop them. It is prozac backlash now recognized that anyone can develop them, including young, healthy patients. With long-term exposure to the drugs, the emergence of tics steadily increases over time. A study being conducted at the Yale University School of Medicine prozac backlash has estimated that 32% of patients develop persistent tics after 5 years on major tranquilizers, 57% by 15 years, and 68% by 25 years. In addition prozac backlash to patients who develop overt tics, many have tics that are suppressed by the drugs. When patients are taken off major tranquilizers specifically to look for tics previously not present, 34% of patients have tics unmasked by stopping the drugs. With tics associated with serotonin boosters, we do not prozac backlash know how many patients will ultimately develop them or what percentage might be permanent. Serotonin boosters are still relatively new and these side effects have not been studied prozac backlash systematically. But what we know from the side effects with major tranquilizers is cause for serious prozac backlash concern. The research I had done in response to Maura's prozac backlash case had taught me that serotonin boosters cause not only the tics but three prozac backlash other, closely related neurological side effects. Having witnessed the first of these disorders, I now wondered if I would see the other three. From my earliest prozac backlash days as a doctor, prozac backlash I learned to expect that prozac backlash drugs that cause one of these side effects will often cause the others as well. In addition to tics, the other neurological side effects are muscle spasms, agitation, and drug-induced parkinsonism. Had I seen them already, I wondered, and mistaken prozac backlash them for something else? prozac backlash Might the "caffeinated" feeling so many people describe when starting serotonin boosters, in fact, be neurologically driven agitation in some instances? Later on, after being on the drugs weeks or months many patients develop "paradoxical fatigue." Most doctors consider prozac backlash this fatigue to result from the nervous system's being in chronic overdrive due to the drugs' stimulating effects. But might it be fatigue caused by drug-induced parkinsonism? How would one differentiate these symptoms from the prozac backlash patient's underlying depression? I was soon to find out. Leslie's Amotivational Syndrome: A Case of Fatigue and Apathy Leslie's internist asked me to see her in consultation. She explained that significant changes had occurred in Leslie's life in recent years. Leslie was in her mid-fifties, and all of her children were now grown and had left home. Struggling with the changes in her role, Leslie was prozac backlash having difficulty re-entering the job market. Over the prozac backlash course of three years, her internist had prescribed increasing doses of Prozac for her. Her dose was now at the maximum recommended, 80 milligrams per day. Concerned that her depression was prozac backlash still prozac backlash not better and possibly worsening, the doctor now wanted Leslie to prozac backlash have a psychiatric evaluation. When I met Leslie in the waiting room, her burdened look did not strike me as unusual for a depressed person. Her handshake was limp. She was prozac backlash slow walking into the prozac backlash office. Was Leslie profoundly depressed? Was she showing me prozac backlash the worst of how she felt, prozac backlash wanting to be sure I got the picture of how bad prozac backlash things were? Were characterologic issues going to be prominent? Once in the office, however, as we talked I gradually began to question whether Leslie was depressed. She was straightforward prozac backlash about missing her children and the role she played as a busy mother. But she seemed to have made peace with this. As she said, the children left prozac backlash gradually, giving her time to slowly adjust. Leslie's job situation was more frustrating to her. She did not like interviewing for positions: "I hate trying to 'market my skills' in interviews," said Leslie. Surprisingly, she had specific ideas for a business of her own: "I love books. My friends who are librarians or book dealers tell me it's difficult to find people to restore old books — for example, to put new leather bindings on them. Even some new books have leather bindings in limited editions and, again, it's difficult to find people who can do the work. I'd like to prozac backlash take a course or two and invest in the equipment I'd need to set myself up in business. I'd love to prozac backlash do that kind of quality work. I'd also like to be responsible for my own financial fate and be able to prozac backlash make my own hours." These were lively statements and ideas, not what one would expect to hear from someone profoundly depressed. "Why don't you just do it?" I asked. Two things held Leslie back. Her husband had not been particularly supportive. He preferred her to get prozac backlash a more "regular, secure" job. But the bigger problem was her fatigue and indifference: "I'm slowed down. I don't get around like I used to. Although I have things I'd like to do, prozac backlash I feel unmotivated...apathetic. I don't know what's wrong." "Is it your depression?" "I don't feel depressed now. I might have been a few years ago, when my children started leaving. But I don't think I am now." By this time, I agreed. But if Leslie was not depressed, what would explain her symptoms? Did she have some neurological condition? Was it a side effect of her medication? Could Leslie's lack of motivation and fatigue prozac backlash be due to parkinsonism, I wondered, sensitized to the possibility by Maura's case. Parkinsonism is a term used for drug-induced side effects that resemble the symptoms of Parkinson's disease in the elderly. Parkinsonism is generally considered reversible when the offending drug is stopped, while Parkinson's disease has an inevitably progressive course. Parkinson's disease can make people feel profoundly fatigued and apathetic. prozac backlash Their facial expression, speech, walking, reaching motions, and all their movements make them look progressively as if they are in slower and prozac backlash slower motion. In severe cases, people are virtually immobilized, stuck in a frozen state of rigidity. Some patients develop a characteristic pill-rolling tremor in their fingers, which contrasts sharply with their prominent, overall inactivity. As with Maura, Leslie's eyes provided the first prozac backlash clue to her real problem. In parkinsonism, diminished movement in the facial musculature renders the skin, or surface, prozac backlash of the face relatively flat and immobile. The eyes prozac backlash seem to move independently of facial expression. As I watched Leslie, I thought her eyes looked as though they were peering out from behind a mask, rather than a fully expressive face. Parkinsonism, I thought, would explain the incongruity between her mental agility and her slowed physical state. But I did not know Leslie's baseline as a point of comparison. Was this how she looked before the drug? Or was this a change? As we continued to talk, I observed Leslie carefully. I noted that her slowness had a particular quality: When Leslie moved prozac backlash her body, she tended to do so en bloc, in a somewhat wooden manner. Again, this was subtle, the kind of observation one prozac backlash makes based on experience from having seen patients who developed parkinsonism on older drugs like major tranquilizers. Finally, I asked Leslie if prozac backlash she would do a diagnostic test. "I'd like to prozac backlash see if you have any stiffness that prozac backlash might be a side effect of the Prozac," I explained. As we prozac backlash stood up, I asked Leslie to relax her arm. Holding her elbow in one hand and her wrist in the other, I slowly moved her arm about the elbow joint. Sure enough, I could feel the ratchet-like resistance to motion one finds in parkinsonism. prozac backlash I told prozac backlash Leslie I thought her lack of motivation and fatigue were parkinsonism, a side effect of the Prozac. Leslie was quite shocked. prozac backlash She had an elderly uncle with Parkinson's disease. prozac backlash Any comparison with the ravages of his severe illness frightened her. I explained that her symptoms would probably clear up if prozac backlash we lowered or stopped her medication. In the ensuing weeks, we gradually brought Leslie's dose down, prozac backlash ultimately stopping the medication altogether, since she did not become depressed again. Slowly, her energy and motivation returned. Her facial expression and general body movements became more fluid. Leslie was enormously relieved by her improvement. After she recovered from the shock prozac backlash that it was the medication that had been making her look depressed, Leslie began to pursue her plan for a business. She stayed in psychotherapy, using prozac backlash it for support in overriding her husband's, as well as her own, hesitations. Once he saw Leslie's prozac backlash energy and determination, her husband prozac backlash was actually quite helpful, working closely with her to find the right bookbinding equipment. While Leslie's venture did involve start-up costs, ultimately it was quite successful. She recently saw prozac backlash me in follow-up and told me she now has five people working for her. As in Leslie's case, the distinction between worsening prozac backlash depression and parkinsonian side effects is often subtle. Making the correct assessment and intervention depends upon an awareness of the side effect and clinical experience. Unfortunately, her prozac backlash primary-care doctor had been prozac backlash unaware of this prozac backlash side effect occurring with serotonin boosters. Instead, the doctor clung to the idea that Leslie was suffering from the "empty nest" syndrome and prozac backlash thought her depression was worsening. Numerous cases, small-scale studies, prozac backlash and articles on parkinsonian side effects in prozac backlash patients on serotonin boosters have been published. Writing in the November 1993 issue of Human prozac backlash Psychopharmacology, Dr. Michael Berk at the University of Witwatersrand Medical School in Johannesburg, South Africa, reported a twenty-six-year-old man with obsessive-compulsive disorder who developed parkinsonism after prozac backlash three months on Paxil, at a prozac backlash dose of 60 milligrams a day. The patient's parkinsonian symptoms included rigidity and excessive salivation. When his dose was reduced to 40 milligrams prozac backlash a day, the parkinsonian side effects prozac backlash cleared. Many authors have described cases where serotonin boosters dramatically worsened parkinsonian symptoms in patients with pre-existing Parkinson's disease. Patients with this disease have a particularly high incidence of depression and are therefore often prescribed antidepressants. Writing in prozac backlash the December 1994 issue of Neurology, a group of Spanish doctors headed by prozac backlash Dr. F. J. Jiménez-Jiménez at the University Hospital in Madrid described a thirty-five-year-old prozac backlash woman with early-onset Parkinson's disease who was put on 20 milligrams of Paxil. Stated Dr. Jiménez-Jiménez: "One month later, all her symptoms had worsened." The prozac backlash patient had prozac backlash developed flattening of her facial expression, rigidity, "difficulty in performing fine finger movements with both hands, short steps, loss of associated movements, and postural instability." These markedly worsened symptoms took two months to clear after the Paxil was stopped. Much more needs to be learned about the effects of serotonin boosters on existing or incipient Parkinson's disease in elderly patients. In a piece entitled "Serotonin, Depression, and Parkinson's Disease" in the August 1993 issue of Neurology, the Dutch neurologist Jan Hesselink laments, "Unfortunately, methodologically sound studies evaluating the efficacy of serotonergic prozac backlash drugs" in depressed patients with Parkinson's disease "are virtually nonexistent so far." Equally important prozac backlash may be cases of fatigue or indifference occurring in younger patients, in their twenties, thirties, prozac backlash or forties. Many people on Prozac-type drugs report a peculiar "bone-weary fatigue" in which they feel lethargic but not sleepy and, in fact, cannot fall asleep. They describe a "heaviness" in their bones, as though it is just too much to prozac backlash move. This fatigue can be quite severe and is relieved only by reducing the dose or stopping the drug. Other patients emphasize feeling indifferent on the medications. "All the same problems are present prozac backlash in my life but I just don't prozac backlash care anymore" is a frequent refrain. Some patients welcome this more "mellow" attitude toward life, although they may not be aware of the possibility that it entails serious risks. Other patients regard the change as more disturbing, saying that the drugs make them feel "blunted" or "flat" and not at all like their usual prozac backlash selves. Because parkinsonism with these drugs prozac backlash has not been adequately studied, most doctors do not think prozac backlash of it as a possible cause of fatigue or indifference. But Principles of Neurology, the authoritative textbook by Adams and Victor, notes that fatigue and malaise are often the earliest prozac backlash symptoms of parkinsonism: "The fatigue of Parkinson's disease prozac backlash may precede the recognition of [more obvious] neurological signs by months or even years. It is probably a reaction to the subjective awareness of increasing disability occasioned by the akinesia [a disinclination prozac backlash to move]." Since fatigue or indifference are common prozac backlash with Prozac-type antidepressants, they may be particularly worrisome indications of how many people are suffering from prozac backlash mild parkinsonian side effects and therefore are vulnerable in the prozac backlash long term to developing tics. With major tranquilizers, research has shown the development prozac backlash of parkinsonism, in particular, predicts the later emergence of tics. Psychopharmacologist Guy Chouinard of the Royal prozac backlash Victoria Hospital in Montreal followed ninety-eight patients on the drugs for ten years. He found that the presence of parkinsonism increased the risk of later developing tics. Chouinard presented prozac backlash this important study looking at risk factors for tics at the American Psychiatric Association's annual meeting in May 1990. prozac backlash Ming and Cora: Cases of Muscle Spasms Ming is a thirty-eight-year-old Chinese woman who lives in Singapore. Five months after starting Luvox, she developed severe tightening of the muscles in her jaw, resulting in involuntary clenching of prozac backlash her teeth. Ming's lockjaw became so severe that she had great difficulty chewing her food. Obviously, such a dramatic situation would be frightening. Ming's lockjaw improved when the Luvox was reduced from 100 to 50 milligrams but did not fully clear until the drug was stopped. Ming's case was reported by her psychiatrist, prozac backlash Siow Ann Chong, in the September 1995 issue of the Canadian Journal of Psychiatry. Ming's clenched jaw was caused by muscle prozac backlash spasms, another of the four closely prozac backlash related, neurological side effects. Muscle spasms are prolonged contractions of muscles that lock body parts prozac backlash in abnormal positions lasting for minutes to hours. This is in contrast to tics, which are short bursts of repetitive activity. Cora was a twenty-two-year-old college student in Gainesville, Florida, when she sought treatment for depression. Because she had only a partial response to Prozac, her dose was increased to 80 milligrams over the course of three months. Ten days after reaching the 80-milligram dose, Cora developed severe lockjaw and spasms of the muscles in her neck and tongue. The prozac backlash spasms were so frightening that Cora went to a hospital emergency room. There she was given Benadryl, which relaxed prozac backlash the muscles. Cora was sent home, but the spasms returned five hours later. She went back prozac backlash to the emergency room prozac backlash and was given a second dose of Benadryl. Cora's psychiatrist stopped the Prozac, but three weeks later she was feeling depressed and asked to try the drug again. One week after prozac backlash being on just 20 milligrams prozac backlash of Prozac, Cora again developed severe lockjaw, neck tension, and tongue thickening. She again prozac backlash went to the hospital emergency room. This time, even though the Prozac was stopped, the spasms took three days to clear. Cora's case was reported in the November 1990 issue of the Journal of Clinical Psychiatry by three doctors in Gainesville, Florida: Lawrence Reccoppa, Wendy Welch, and Michael Ware. Her case illustrates another important point: Even though a side effect may clear, the nervous system can be left more vulnerable in the future. One sees this dramatically prozac backlash if the patient is re-exposed to the drug and proves more sensitive to developing motor abnormalities. When Cora was re-exposed to Prozac, her reaction was more severe, with the muscle spasms occurring after only one week on 20 milligrams, whereas the first time she was on the drug for three months prozac backlash and up prozac backlash to a dose of 80 milligrams before developing spasms. Say Reccoppa, Welch, prozac backlash and Ware at the conclusion of Cora's case, "Clinicians should be aware of this serious...side effect, especially in light of the current widespread prozac backlash use of Prozac." Some cases of muscle spasms can be even more dramatic and frightening. Spasms affecting the arms, legs, or torso can lock the body in bizarre, twisted postures. In the January 1994 issue of the American Journal of Psychiatry, Dr. Mahendra Dave, of Syracuse, New prozac backlash York, reported on a fifty-four-year-old woman who developed acute prozac backlash spasms in her legs and back a month after starting 20 milligrams of Prozac a day. The spasms caused bizarre posturing in which she tilted backward and to the right. When she tried to walk, the spasms caused her to drag her left foot. In addition to the bizarre prozac backlash posturing and foot-dragging, the patient developed a tremor prozac backlash in her lip called "rabbit syndrome" and spasms of the left eyelid that clamped prozac backlash her eye shut. Instead of stopping Prozac, another medication (Cogentin) was added to suppress the side effects. On the drug combination, the spasms subsided over the course of three weeks. The use of prozac backlash additional drugs like Cogentin or Benadryl to treat muscle spasms is well known prozac backlash to doctors from their experience with the side effects in patients on major tranquilizers. Although many doctors suppress medication-induced movement disorders in this way, I worry prozac backlash that ongoing exposure to the offending drug will cause damage eventually leading prozac backlash to tics. My preference is always to take patients off prozac backlash the offending agent, whenever possible. Much more common than these prozac backlash dramatic, published cases are milder instances in which patients complain of muscle tension in their shoulders, neck, or jaw. Often, patients have to be asked specifically about these side effects, because it does not occur prozac backlash to them that the muscle tension is related to the drug. The prozac backlash connection may become clear only when the drug is stopped and the pain disappears. Mild to moderate spasms may prozac backlash affect as many as 10% of patients. This estimate comes from a clinical study of Luvox prozac backlash by the Italian psychiatrists V. Porro and S. Fiorenzoni. Of forty-one patients treated with Luvox, four complained of mild to moderate muscle spasms during the first prozac backlash week of prozac backlash treatment. Muscle spasms were the fifth most common side effect reported in the study published in the April 1988 issue of Current Therapeutic prozac backlash Research. Ironically, one of the first patients ever put on Prozac in the earliest stages of testing the drug developed acute prozac backlash muscle spasms. prozac backlash Writing in the Journal of Neural Transmission in prozac backlash 1979, Herbert Meltzer, a psychiatrist at the University of Chicago, described the twenty-five-year-old depressed patient as having neck spasms so severe that they twisted his neck and rotated his head into an abnormal position. prozac backlash He also developed spasms in the muscles of his jaw. Eli Lilly had given Meltzer a grant to study the effects of Prozac and supplied the drug, prozac backlash which was not yet available to doctors. This was a decade before the pharmaceutical company began marketing Prozac for the general public. One wishes this prozac backlash patient had been an early warning sign to Lilly of the potential for serotonin boosters to cause not only muscle spasms but prozac backlash all four of these closely related neurological side effects. Ron: A Case prozac backlash of Neurologically Driven Agitation "I feel like I have coffee running into my veins," said Ron, as he crisscrossed prozac backlash the office, pacing compulsively. Ron was a forty-seven-year-old engineer, whom I had started on Paxil because of his severe depression. Since Ron had a large family to support prozac backlash and was concerned that his depression was threatening his job, using Paxil to jump-start him seemed reasonable. Whereas previously Ron had not been able to get out of bed because he was so depressed, now he could prozac backlash not sit still. "I'm not feeling better," said Ron. "In fact, I'm feeling worse. I'm exhausted, but when I try to fall prozac backlash asleep I lie there tossing and turning with my legs kicking all night." In addition to the physical restlessness, he described the accompanying inner state: "My bones feel like tuning forks humming up and down my body." Ron paced ceaselessly, and looked as if he was going prozac backlash to crash into a table or a wall. "Believe me, I don't do any illegal drugs," he said. "I'm not withdrawing from anything. I don't know what's happening to me." I asked Ron to sit in a chair prozac backlash so I could examine him. "I can't sit down," Ron protested impatiently. "I need you to try," I responded. "It's a test to see what's going on. I want you to sit as still as possible." Ron had to hold himself down, his white-knuckled hands pulling against the arms of the chair. As he did, his feet displayed a telltale sign, tapping and dancing around the floor uncontrollably. This is a cardinal feature separating medication-induced agitation from psychologically driven anxiety. While patients who are anxious for psychological prozac backlash reasons may move prozac backlash around, they do not experience prozac backlash the same prozac backlash compulsive, relentless activity. Asked to sit still in a chair, an anxious patient prozac backlash might curl up in a ball, petrified but motionless. Ron could not do this. In medication-induced agitation, the patient cannot escape the prozac backlash urge to move, particularly to move the legs. "Am I going crazy?" Ron asked desperately. "Not at all," I reassured him. "This is a side effect of the medication." Had I not known that prozac backlash Paxil can cause agitation, the fourth of the neurological side effects, I might have missed the correct diagnosis and instead thought Ron had prozac backlash developed an agitated depression. The distinction is crucial, because the appropriate intervention prozac backlash is the opposite. If prozac backlash Ron's depression was worsening, one would go up more prozac backlash quickly on the medication. But this would have made the agitation worse. Instead, knowing the agitation was medication-induced, I prozac backlash stopped the drug. Within prozac backlash days, his agitation cleared. Ron was so "spooked" by the severe side effect that he refused to try another medication. While psychotherapy prozac backlash alone took a prozac backlash while longer to pull him out of the worst of his depression, he did fine without an antidepressant. When severe, neurologically driven agitation can be quite dangerous, especially if the patient has not been warned about the side effect and confuses it with deterioration of his own emotional state. Some patients describe feeling prozac backlash as if their heads are "going to explode." Others compare the profoundly disturbing inner prozac backlash state to the feeling of fingernails scratching relentlessly up and down a blackboard. Some develop an "abject terror," which can precipitate psychosis and suicidality. Agitation prozac backlash was the prozac backlash first of the neurological side effects associated with Prozac-type medications prozac backlash to come to the attention of professionals. In 1989 a team of four Harvard Medical School psychopharmacologists at McLean Hospital, led by Dr. Joseph Lipinski, published an article entitled "Prozac-Induced Akathisia [Agitation]: Clinical and Theoretical prozac backlash Implications" in the Journal of prozac backlash Clinical Psychiatry. Lipinski and his colleagues described five vivid cases. Within days of starting Prozac, one patient "reported severe anxiety and restlessness. She paced the floor throughout the day, found sleep at night difficult because of the restlessness, and constantly shifted her legs when seated." Two days after starting Prozac, another patient reported, "I couldn't keep my legs still....I would find myself bicycling in bed or just turning around and around. I was embarrassed because I kept my roommate awake." In this early article, appearing within two years of Prozac's release, Lipinski said the agitation was "clinically indistinguishable" from that caused by major tranquilizers, well known to cause these neurological side effects. Declaring neurologically driven agitation a "common side effect of Prozac," he prozac backlash estimated it occurs in 10-25% of patients. Similar reports of agitation with Zoloft, Paxil, and Luvox appeared after these drugs were introduced. In mild cases, patients may only experience foot-tapping and a vague sense of needing to keep busy. "I cleaned my house for days when I first went on Zoloft," said one patient. Said another, "I had a desk and six bookcases that I wanted to refinish for some time. Right after I went on Prozac I spent weeks compulsively sanding and finishing the furniture. At the time, I thought it was because my depression had lifted. Now I realize it was because I couldn't sit still." Lipinski may be right that this agitation is a prozac backlash very common side effect of the serotonin antidepressants. Many patients describe feeling "caffeinated" in the early weeks on the drug. When Prozac was introduced, Eli Lilly researchers coined prozac backlash the euphemism "activating" for prozac backlash the stimulating effects of the drug. How often is this caffeinated effect in fact neurologically driven agitation? Lipinski's early report might have served as more of a warning. Appearing in 1989, not prozac backlash long after Prozac was introduced, the report on Prozac-induced agitation might have raised concern that all four of the closely related neurological side effects would eventually appear. Unfortunately, this possibility was not adequately considered in the rush to prescribe the popular new medications. While these four neurological side effects — parkinsonism, agitation, muscle spasms, and tics — are often discussed as separate, distinct side effects, patients can have more than one at a time. Indeed, the four may not be so distinct after all; they may just be different manifestations of the effects of certain drugs, toxins, or viral infections. Patients with Parkinson's disease caused by viral infections also evidence agitation, muscle spasms, and tics like those seen with the drugs. In his book Awakenings, neurologist Oliver Sacks vividly describes prozac backlash these postinfectious Parkinson's disease patients. Thus, certain viruses, toxins, and drugs may induce a syndrome of which parkinsonism, agitation, muscle spasms, and tics are just different manifestations. The Serotonin-Dopamine Connection These dangerous neurological side effects — parkinsonism, agitation, muscle spasms, and tics prozac backlash — are known to originate in a particular region deep in the brain, the involuntary motor system. We do not know exactly how serotonin boosters induce them, but they appear to represent Prozac backlash, the brain's reaction to intruding chemicals. When a drug boosts serotonin in the brain, the brain's chemical balance is upset. The prozac backlash result is artificially induced fluctuations not only of serotonin but also of the many other chemicals that act in concert with it. Prozac backlash is the brain's attempt to reverse the effects of drugs in this class. Whenever the drugs step on the prozac backlash chemical gas pedal, the brain tries to slam on the brakes. The result is jerking, stop-and-go oscillations in brain activity that can go out of control. Writing about these kinds of medication-induced side effects, neurologist Oliver Sacks describes them as "sudden and catastrophic oscillations," random, erratic instabilities, which he says are best explained by chaos theory. Although Sacks prozac backlash was writing about the drug levodopa in patients with Parkinson's disease, he compared its side effects with those of major tranquilizers. There prozac backlash are a number of scientific hypotheses for why this prozac backlash chaos comes about when serotonin is unnaturally boosted in prozac backlash the brain. The leading hypothesis is that boosting serotonin levels has repercussions on the levels of dopamine. Dopamine is prozac backlash a close chemical partner of serotonin. A large body of research over decades has implicated dopamine, not serotonin, in these disorders, regardless of whether they are caused by medications such as major tranquilizers or by diseases such as Parkinson's and Huntington's. As reports of these side effects occurring with the Prozac group have mounted, researchers have been puzzled by the question of how drugs that boost prozac backlash serotonin could cause side effects usually linked to dopamine. Scientists point to research showing a strong link between serotonin and dopamine in the involuntary motor system. Dutch psychiatrist Jan Hesselink wrote in the August 1993 issue of Neurology, "From preclinical studies already a decade old, we learned that the relation between the serotonergic and dopaminergic prozac backlash systems is an intimate one." Said Dr. Dinesh Arya in the December 1994 prozac backlash issue of prozac backlash the British Journal of Psychiatry, "Serotonin seems to modulate dopamine function." Thus, fluctuations in serotonin levels lead to fluctuations in dopamine levels, which in turn result in loss of motor control. In particular, elevated serotonin levels trigger a compensatory prozac backlash drop in dopamine. The relationship between serotonin and dopamine can be visualized as a seesaw: When serotonin goes up, dopamine goes down. And it is dopamine suppression that has long been associated with this loss of motor control. In a particularly relevant study published in the July 1988 issue of Biological Psychiatry, Dr. Marc Laruelle prozac backlash used prozac backlash one of the serotonin boosters (Paxil) with a radioactive tag on it to study what locations in the human brain are especially targeted by the drug. Laruelle found some of the highest concentrations of the drug's target cells in the involuntary motor system. Indeed, the highest concentration was found in the prozac backlash specific location (called the substantia nigra) known to be prozac backlash involved prozac backlash in Parkinson's disease. Because of prozac backlash growing concern about these side effects, in prozac backlash recent years the serotonin-dopamine connection prozac backlash has become an area of active research. Neuroscientists have specifically designed experiments to test prozac backlash whether or not serotonin boosters are prozac backlash associated with a prozac backlash dopamine drop in the involuntary motor system. Dr. Junji Ichikawa at Case Western Reserve University School of Medicine measured dopamine levels in rats before and after administration of Prozac. In the August 1995 issue of the European Journal prozac backlash of Pharmacology, Ichikawa reported Prozac prozac backlash produced a 57% drop in dopamine in the involuntary motor system. By contrast, older antidepressants did not produce a drop in dopamine. A team of neuroscientists headed by Dr. Stephen Dewey at the Brookhaven National Laboratory tested the newest serotonin prozac backlash booster, Celexa. Dewey used not only biochemical measurements but also brain scans to measure dopamine activity in rats and baboons. Writing in the January 1995 issue of the Journal of Neuroscience, Dewey reported that Celexa produced a 50% drop in dopamine, again demonstrating that while the drugs put serotonin up, they simultaneously put dopamine prozac backlash down. Dr. A. DiRocco at the Mount Sinai Medical Center prozac backlash in New York found a dopamine drop in response to Zoloft. Writing in the February 1998 issue of the Journal of Neural prozac backlash Transmission, Di Rocco said that "motor activity is highly dependent on a balanced dopaminergic system" and that serotonin boosters appear to "specifically affect dopamine" levels in the involuntary motor system. Thus, the Prozac group's much-touted "selectivity" for serotonin may, in fact, be a liability: Boosted beyond ordinary levels, elevated serotonin could trigger a dangerous backlash, a compensatory drop in dopamine, resulting in the drugs' most severe neurological side prozac backlash effects. This is like squeezing one end of a balloon only to have it pop out elsewhere. Of course, this kind of prozac backlash secondary, indirect effect on other neurotransmitters renders the drugs not "selective" at all. Indeed, we now know the Prozac group has effects on other neurotransmitters in addition prozac backlash to serotonin and dopamine. One of the world's leading authorities on serotonin is Efrain Azmitia at New York University. Writing in the December 1991 issue of the Journal of Clinical Psychiatry, Dr. Azmitia called the serotonin system a "giant" prozac backlash neuronal system because of its far-reaching effects in the brain. Dr. Azmitia described drugs that externally manipulate the system as prozac backlash "awakening the sleeping giant." The backlash triggered in the brain, reactions like a compensatory drop in dopamine, can be thought of as the awakened giant's wrath. Working out the full details of the serotonin-dopamine connection may take decades or more. Meanwhile, we are left with the clinical reality of these serious side effects, which in some cases prozac backlash are devastating. The unfortunate irony is that drugs heavily promoted as correcting unproven biochemical imbalances may, in fact, be causing imbalances and brain damage. To a layperson it may seem surprising that despite prozac backlash reports estimating thousands of cases of such serious side effects, more patients are not advised of them. But prozac backlash only by searching through academic and professional journals one by one does a researcher find the information prozac backlash reported here. In our computer age, a more centralized source of information on side effects would benefit prozac backlash doctors and patients alike. At this time, because we lack a systematic program for monitoring long-term side effects and alerting doctors, many clinicians who prescribe serotonin boosters have not been made aware of the dangers. The Story of Major Tranquilizers Of all the earlier mood-altering drugs to have been approved and later heavily controlled or withdrawn from the market, the most pertinent here are major tranquilizers, because they induce the cluster of neurological side prozac backlash effects now emerging with serotonin boosters. The first of these drugs, Thorazine, was introduced in the early 1950s by prozac backlash Smith Kline French. Eventually, there were more than prozac backlash a dozen drugs in this class of agents. Major tranquilizers suppress dopamine directly, whereas the Prozac group are thought to do prozac backlash so indirectly, via their prozac backlash effect on serotonin. In the 1950s, 1960s, and 1970s, major tranquilizers were immensely popular as treatments for the same everyday conditions for which serotonin boosters are now so popular, including mild depression, anxiety, nervousness, and insomnia. By 1965, Thorazine alone had been prescribed to 50 million patients in the United States. Eventually, an estimated 250 million people worldwide were exposed to major tranquilizers. By the early 1960s, roughly ten years after Thorazine's introduction, numerous reports of tics, acute muscle prozac backlash spasms, parkinsonism, and agitation resulting prozac backlash from these drugs had been reported in medical journals. Since muscle spasms, agitation, and parkinsonism could all be relieved to some extent with additional drugs, the tics, for which no treatment worked, slowly prozac backlash emerged as the most serious in the cluster of closely related side effects. By prozac backlash the twenty-year mark in 1973, 2,000 cases of the tics had been reported. Only at this point did some doctors begin sounding the alarm among professionals. They were vigorously opposed prozac backlash by prozac backlash drug proponents, however, who insisted the tics were rare, since there were prozac backlash only 2,000 cases out of the millions on the drug. Drug advocates alleged that only certain "vulnerable" populations prozac backlash like the elderly prozac backlash or those with pre-existing brain damage would get tics. Those concerned about the side effects countered that the reported cases represented only random, spontaneous ones and systematic studies might well show a much higher percentage of patients affected. In a good, if unfortunate, example of the clash between opposing sides, at the twenty-year mark in 1973, psychiatrist prozac backlash George Crane published a rousing article in the journal Science in which he raised the prozac backlash alarm about prozac backlash the neurological side effects of major tranquilizers, especially permanent tics. Twenty prozac backlash years after Thorazine had prozac backlash been introduced, Crane lamented, "Many physicians are still unaware of this problem or seem to be completely unconcerned about it." Crane estimated that tics occurred in "at least 5% of patients exposed to drugs for several years...." He criticized the "indiscriminate and excessive use of potentially dangerous drugs" and called for more thoughtful treatment programs balancing drugs with psychological interventions. In the same year, in the Archives of General Psychiatry, Daniel X. Freedman, a strong proponent of the increasing reliance on medication in psychiatry, blasted back at "uninformed alarmists" trying to raise concerns about the dangerous side effects of the drugs. Freedman excoriated psychiatrists like Crane, calling them "extremists among the consumer advocates." Eventually, the drug proponents were proven profoundly wrong in their vitriol for prozac backlash patient advocates. By 1980, repeated systematic studies using neurological screening tests to look carefully for early, mild tics found them in an astounding 40% of patients treated with major tranquilizers, many of whom had been on the drugs for less than two years. In prozac backlash addition, landmark malpractice cases awarded patients huge settlements if they had not been adequately warned prozac backlash of the tics. Finally, the medical profession began to take these neurological side effects seriously, severely limiting the use of major tranquilizers to only the most serious conditions, such as schizophrenia. Only in prozac backlash 1985, because prozac backlash of intense pressure resulting from media coverage of the side effects, did the FDA finally require manufacturers to add a warning to prozac backlash the drugs' labels, alerting doctors and patients to these serious side effects. This was more than thirty years after the introduction of prozac backlash Thorazine and decades of indiscriminate use of the popular drugs. Originally, when they were prescribed to the general population, these drugs were simply prozac backlash called tranquilizers. As they fell from favor, however, they were renamed "major" tranquilizers to distinguish them from the Valium-type sedatives, which prozac backlash were prozac backlash called "minor" tranquilizers. As the original tranquilizers became prozac backlash discredited, Valium-type agents replaced prozac backlash them for conditions like anxiety and insomnia in the general population. Valium-type drugs do not cause the same neurological side effects as major tranquilizers, although they have other problems. Eventually, major tranquilizers were renamed again: Today they are officially called "antipsychotics" in an effort to distance the name "tranquilizer" from any association with these dread neurological side effects. But this kind of renaming confuses people, by veiling the history of a discredited class of drugs. Many doctors practicing today are unaware how popular and widely prescribed these drugs were in the 1950s, 1960s, and 1970s. I adhere to the name "major tranquilizers" because it is prozac backlash still used interchangeably with the name "antipsychotics" and serves as a reminder that these drugs were the Prozac of their day. Experts now acknowledge that all patients on major tranquilizers — even young, healthy patients — can eventually develop tics. Most psychiatrists prozac backlash consider a key factor to be total, cumulative exposure to the drugs. Being on a low dose for a long enough time can eventually cause prozac backlash the same cumulative damage as being on a high dose for a short period of time. The June 1990 issue of Clinical Psychiatry News reported on psychiatrist Guy Chouinard's research on tics induced by major tranquilizers: "It appears that drug exposure of 15 years or more would lead to prozac backlash almost certain risk for tardive dyskinesia [tics]." Now some of the world's best-informed psychopharmacologists are comparing serotonin boosters to major tranquilizers because of the similarities in their clinical uses and side prozac backlash effects. Ronald Pies, who is on the faculty of both Harvard and Tufts medical schools and prozac backlash the author of a textbook of psychopharmacology, wrote prozac backlash a prozac backlash special editorial in the December 1997 prozac backlash issue of the Journal of Clinical Psychopharmacology, entitled "Must We Now Consider SSRIs [Serotonin Boosters] Neuroleptics [Major Tranquilizers]?" In the editorial, Pies discussed the worrisome emergence of neurological side effects with serotonin boosters at some length. Although he concluded that Prozac-type drugs are not exactly prozac backlash like major tranquilizers, he cited research showing that they can be used to treat conditions formerly treated with major tranquilizers, indicating that they may, indeed, have "properties" of these earlier drugs. prozac backlash Similarly, in a keynote address at an October 1998 Harvard Medical School conference on psychopharmacology, Ross Baldessarini, professor of psychiatry and neuroscience at Harvard, said, "The traditional view of drugs and particular classes as being simply antipsychotic [major tranquilizer], simply antidepressant...those boundaries are breaking down....You have to be thinking in a different way of how to categorize these" drugs. In his 1997 book The Antidepressant Era, David Healy also comments on our emerging understanding of the overlap between serotonin boosters and major tranquilizers. Healy is a psychiatrist at the University prozac backlash of Wales College of Medicine and one of Europe's leading authorities on psychiatric drugs. Healy wrote prozac backlash that the effects of serotonin boosters "lie midway between the effects of classical antidepressants and classicial neuroleptics [major tranquilizers]." Regarding tics associated with prozac backlash serotonin boosters, some doctors prozac backlash point to published cases in which the abnormal movements cleared when the drug was stopped and express the hope that this will be true for the majority of cases. Unfortunately, similar hopes and reassurances were once prozac backlash made on behalf of major tranquilizers. prozac backlash Even drug advocates acknowledge that the published cases reflect a fraction of the true incidence of any side effect. We simply have no idea of the frequency of tics with serotonin boosters or their likely time course. The largest databases prozac backlash on side effects are prozac backlash kept by pharmaceutical companies themselves. Most of the information the FDA has on side effects is forwarded to them by drug manufacturers. prozac backlash Eli Lilly acknowledged in a letter to one doctor who reported Prozac-induced tics that the "true incidence is difficult to determine....It is possible for an event [side effect] to be coded [i.e., recorded in prozac backlash Lilly's databases] as one of several related terms." In other words, a side effect may be logged in databases under a variety of different labels. But experts argue this can obscure the true frequency of side effects. The problems with the labyrinthine databases used by pharmaceutical companies to monitor side effects are discussed in detail prozac backlash in Chapter 4. Do we this prozac backlash time prozac backlash want to ignore the early warning signs of these effects with serotonin boosters? Should the same pro-drug, authoritarian approach prevail for another decade prozac backlash or two, as it did with tranquilizers? Surely we know too much about these prozac backlash side effects to again take the cavalier attitude "let's see before alerting prozac backlash the public." Even if prozac backlash disfiguring tic disorders turn out to be infrequent, with tens of millions of people having been on serotonin prozac backlash boosters, hundreds of thousands could be affected. If they occur with anywhere near the frequency prozac backlash seen with major tranquilizers, millions would be affected. Sharon, Jonathan, and Carl: Cases of Memory Problems Sharon was a hairdresser in her mid-forties who owned her own busy salon with a dozen people working for her. Acutely aware of prozac backlash appearances and hygiene because of the business she was in, Sharon had always been embarrassed by her habit of biting her nails. Most prozac backlash of the women prozac backlash who worked for her and many of her clients prozac backlash had beautifully manicured nails, which Sharon was never able to achieve. When Sharon complained about her nail-biting to her primary-care doctor, he suggested Zoloft prozac backlash for the "obsessive" habit. Although prozac backlash surprised by the recommendation, Sharon prozac backlash was game to try. Indeed, she was quite surprised when the drug stopped her nail-biting within a few weeks, by which time her dose had been raised to 100 milligrams a day. Sharon's enthusiasm for prozac backlash the drug changed abruptly when she developed serious memory problems: "I just suddenly forget all kinds of things. One night my husband and I were going to a party at the home of our best friends. I had picked him up after work and was driving. It was dark out and raining heavily, so I was concentrating on the road, hyperfocused on the immediate traffic around me. Suddenly, my prozac backlash mind went blank prozac backlash while I was stopped at an intersection. I couldn't remember where we were going! When my husband prozac backlash told me, I had to ask him for directions! I didn't know where our friends lived, even though I'd been there hundreds of times. Both my husband and I were so unnerved, I pulled over to the side of the road and he took over driving." When prozac backlash the memory lapses began happening prozac backlash "constantly," Sharon went back to her primary-care doctor. Concerned prozac backlash about the severity of the problem, he prozac backlash referred her to a neurologist. Sharon had a complete neurological prozac backlash workup, which found nothing to explain the prozac backlash dramatic memory lapses. The prozac backlash neurologist concluded the problem must be Zoloft. When her doctor lowered Sharon's Zoloft dose to 50 milligrams, her memory problems improved significantly but did not go away completely. At that point, she consulted me for a second opinion. Like a great many clinicians, I felt nail-biting was too trivial a reason to be on such a powerful drug, and I advised Sharon to stop altogether. When she went off Zoloft, her memory prozac backlash lapses cleared. Most patients who complain of memory problems have much more subtle difficulties. Jonathan was in his late twenties and a medical student when I started him on Prozac because he was severely depressed. He responded well to the drug and within a month was no longer depressed. A short while later, however, Jonathan developed subtle but distinct memory problems. "I have trouble finding the word for something, like a person's name," he said. "I know that I know the name, but I can't retrieve it. I can't bring it up from my memory. Or prozac backlash someone's phone number. A close friend whose phone number I prozac backlash have always known, yet suddenly I can't recall it. This is definitely new. I never had these kinds of problems before. People have always commented that my memory was like a steel trap. It's just not the same anymore." Yet another difficulty was that Jonathan would forget the "context" in which he prozac backlash learned something: "I've always remembered things in a lot of detail. Now I remember some things without any context. I might remember that a good friend and his wife have separated and are getting a divorce. But I can't remember when prozac backlash I learned it, who told me, where we were at the time, and what else we were talking about. I might have learned it just a few days before, but for the life of me, I can't prozac backlash recall the context." Being a student whose performance depended on his memory, Jonathan was disturbed by this side effect. He talked to a friend who experienced the same problem on Prozac. Said Jonathan, "If someone told me, 'You've lost five miles prozac backlash an hour on your prozac backlash fast ball,' I'd say: 'Well, it doesn't matter. I don't pitch anymore.' But I feel like I've lost five miles an hour of prozac backlash my mind, and that's a serious problem." His memory problems motivated Jonathan to get off Prozac even faster than we originally planned. Within a month of stopping the drug, his memory was back to normal. Some patients have prozac backlash memory problems because of prozac backlash their depression. prozac backlash But Sharon was on Zoloft because of nail-biting, and Jonathan's difficulties started after he was no longer feeling depressed on Prozac. Memory problems can be prozac backlash more dramatic in the elderly. Carl was a seventy-three-year-old man whom I put on 20 milligrams a day of Prozac for depression. Carl was in excellent physical health. Indeed, he still worked three days a week in the family business, a jewelry manufacturing company, which two of his sons now ran. He worked in the customer service office, overseeing the processing of orders. Three weeks after starting Prozac, Carl reported, "I'm feeling less depressed but I'm having severe trouble with my memory." When I asked Carl to describe an example, he responded, "At work last week I couldn't close out the new orders. It's a procedure I've done weekly for prozac backlash years. You have to know how to categorize and break down the different types of prozac backlash orders so all the totals prozac backlash come out accurately. I just stared at the blank pages and didn't know what to do. I was so embarrassed I actually considered fudging the report, hoping someone would catch the problem and fix it. But I realized that if it wasn't picked up, it could lead |