The Career of a Celebrity Pill
As Prozac's long reign comes to an end, experts are questioning its legacy
Who would have thought, back in 1987, that a small, green-and-cream-colored pill would become not only the most famous drug ever but a cultural icon? The subject of scholarly analyses, talk show conversations, and comedians' monologues, the antidepressant even made the cover of national magazines. Psychiatrist Peter Kramer parlayed the drug's popularity into a national bestseller, Listening to Prozac, portraying it as a true celebrity with a career of "renown, followed by rumors, then notoriety, scandal, and lawsuits, and finally a quiet rehabilitation."
Before Prozac, the brain chemical serotonin was relegated to obscure medical journals, and emotional disturbances were viewed as something far more complex than chemical imbalances. Nowadays, psychotherapeutic drugs are the third-largest category of drug sales; antidepressants are advertised on television and routinely prescribed by internists; and there are support groups for depressed dogs, some of which take Prozac.
Well, the Age of Prozac is about to end--certainly symbolically but perhaps also in very practical ways. After 13 years, the medication's patent expires in August, and any drug maker will be free to market the unique chemical formulation as a generic drug. It is not entirely coincidental that with the end of Prozac's reign of exclusivity, a number of critics are coming forward to question not only this famous drug's legacy but the exuberance of biological psychiatry more broadly. A spate of new books--Harvard psychiatrist J. Allan Hobson's Out of Its Mind: Psychiatry in Crisis; anthropologist T. M. Luhrmann's Of Two Minds: The Growing Disorder in American Psychiatry; and psychoanalyst Elio Frattaroli's Healing the Soul in the Age of the Brain, to name just a few--underscore the limits of biological psychiatry and drug treatments for the mentally ill. "If my neurotransmitters made me do it, then everything I don't like about myself has a solution that lies outside myself," says Frattaroli. "That is ultimately a very debilitating way of thinking." Harvard psychiatrist Stephen Bergman goes further: "When you line up all the forces that act in psychiatry today, it's pretty scary. The alignment is . . . not in the patient's best interest."
On the rise. Indeed, psychiatric drug sales are expected to grow from $23 billion in 2000 to nearly $42 billion by 2005. At the recent annual meeting of the American Psychiatric Association in New Orleans, the pharmaceutical industry sponsored dozens of symposiums on the newest pharmacological treatment for every mental illness imaginable--mostly in conjunction with fine dining. Between meals, participants could stroll the exhibit hall, where drug company representatives handed out everything from tote bags to CDs and Mardi Gras masks to nearly 13,000 potential prescribers. In 2000, pharmaceutical companies sponsored 22,838 events promoting antidepressants alone; that's up 31 percent since 1999. That same year Eli Lilly grossed $2.6 billion in Prozac sales. Prescriptions for all antidepressants rose from 40 million in 1988 to 120 million a decade later.
It was not always this way. The sea change occurred when Prozac, the first of a class of drugs called selective serotonin reuptake inhibitors, or SSRIs, appeared. Before then the most common drug treatment for depression--called tricyclics--required carefully calibrated doses, had unpleasant side effects, and could be fatal if taken improperly. General practitioners rarely fooled around with the tricky medications; even psychiatrists did not prescribe them freely. While SSRIs also produce some serious side effects, they have proved remarkably effective with some patients, and, most important, they carry almost no risk of overdose.
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