Prozac

Note: Originally published March 15, 2017 by Caroline Lalla; Rewritten April 1, 2017 by Cayenne Buell

Definition of the Term and Background
Prozac, also known by its generic name Fluoxetine, is used to treat depression, obsessive-compulsive disorder, some eating disorders, and panic attacks. It is part of a class of drugs called selective serotonin reuptake inhibitors (SSRIs) which function by increasing the amount of serotonin (a natural substance that helps to maintain mental balance) in the brain (“Fluoxetine” 2017). Prozac can come as a capsule, tablet, or solution and is typically taken once a day by mouth in the morning. Taking Prozac more often than prescribed can result in overdose, which can lead to coma and possible death. Prozac’s side effects range from mild, including nausea, drowsiness, uncontrollable shaking, and loss of appetite, to more severe, such as difficulty breathing, fever, hallucinations, and seizures. Approximately 63% of patients experience side effects. If side effects are severe, discontinuation is often recommended and a different drug is prescribed in its place (Best Buy, 2013). When first starting Prozac, it typically takes four to five weeks to experience its full effects. However, one should not stop taking Prozac out of fear that it is not working because sudden stoppage can cause withdrawal symptoms including mood changes, irritability, dizziness, numbness, anxiety, confusion, headache, and tiredness (“Fluoxetine” 2017).

A 20 mg capsule of Prozac (Prozac 2009)

Historical Context
The birth of Prozac started with the collaboration of Bryan Mooly and Robert Rathburn—two scientists who were researching the development of a new drug to treat depression. David Wong, a scientist from Eli and Lilly Company (the 10^th largest pharmaceutical company in the world) soon took over the development of the drug and released the first description of the generic form of Prozac in a scientific journal in 1974 (Gasbarre, Walden, and Brusin 2010; Wong et al. 2015). Despite its announced discoveries in 1974, Prozac wasn’t approved by the FDA for commercial use in the United States until December 29th, 1987, although it had been approved for use in Belgium a year earlier (Wong et al. 2015). Prozac was the first antidepressant in the new class of SSRI drugs and is now on the World Health Organization’s list of essential medicines. Within years of its release, Prozac reached annual sales of $350 million dollars in sales domestically and $2.6 billion dollars in sales internationally. In 2001, when Eli and Lilly’s patent on the drug expired, their sales dropped over 70%, losing most business to generic competitors. Still, Prozac is one of the most prescribed antidepressant drugs in the world. More recently, in 2010 Prozac became one of four antidepressant drugs the Federal Aviation Administration (FAA) permits pilots to take while operating airplanes (Federal Aviation 2010). However, Prozac still carries a large risk of overdose and suicide, and as of 2007, the FDA requires every Prozac container to contain a label warning of increased risks of suicide while taking the drug (Wong et al., 2015).

Controversy/Debate
Currently, anyone over the age of 8 is eligible to be prescribed Prozac, given they meet the necessary criteria for an illness/disorder that is treatable with the drug (Application n.d.). Because of the addictive nature and adverse side effects of Prozac, the low age restriction has resulted in substantial controversy regarding the prescription of Prozac to children. Many experts believe that Prozac isn’t necessary to deal with children’s behavioral and emotional problems and argue that parents and pharmaceutical companies are trying to medicalize every difficulty in parenting children. According to a study that assessed the public’s opinion of giving Prozac to children, individuals were significantly less likely to say that they would allow children to take Prozac compared to other psychiatric drugs, such as Ritalin (McLeod et al., 2004). The researchers theorized that this may be due to a general reluctance among the population to accept children’s problems as medical disorders, regardless of the increasing rates of prescriptions to young children. Many who were surveyed questioned whether the problems in children that Prozac was prescribed to remedy were even medical problems at all, pointing out that they could just as easily be linked to parenting deficits and childish phases. However, adults who used or knew someone who used Prozac and had seen positive results were more likely to say they would prescribe the drug for children. But even then, an overwhelming percent of these same adults still said they were hesitant to prescribe Prozac to children, possibly because the public still has not fully embraced the medicalization of children’s problems and typically believe that these problems do not warrant medical treatment. The experimenters also argue that the hesitation to put children on Prozac could stem from the media’s controversial stigmatization of mental illness and from the public’s stigmatization of troubled kids (McLeod et al., 2004). Overwhelmingly, when asked, individuals felt that intervention programs that did not utilize Prozac would help kids to better avoid the label of mentally ill and lead them away from possible drug dependence.

How It Relates to Public Health
Statistically speaking, Non-Hispanic whites are far more likely to be prescribed Prozac than any other racial group, with approximately 13.6% taking antidepressants in the United States. In contrast, 3.9% of African Americans take antidepressants, and only 2.7% of Mexican Americans receive prescriptions for antidepressants such as Prozac (Pratt, Brody, and Gu 2011). Examining the racialization of Prozac and other antidepressants draws clear connections to the politics of health. One possible cause for this racialization, for instance, involves structural boundaries such as SES and geographic location that may enable or prevent individuals from seeking treatment (Schnittker 2003). Anna Mollow (2013) highlights these barriers in her argument that the lack of access to healthcare is the most oppressive aspect of the politics surrounding mental illness and its prescription drugs. Even when minority groups have access healthcare, they are often misdiagnosed and their concerns are dismissed, as in Mollow’s case where her symptoms where disregarded as hormonal rather than medically diagnosable depression. Just as a mental illness diagnosis and Prozac prescription can bring about social problems, so can a lack of diagnosis and prescription (Mollow 2013). This flipped discrimination is a problem almost unique to those in the African American community, which emphasizes the racialized nature of Prozac.

Drawing on the stigmatization of minority groups and mental illness, Schnittker (2003) explores the discrepancies of Prozac prescriptions between races, placing an emphasis of his research on African Americans. When controlling for access to care and prescription rates, African Americans are way less willing to use Prozac or administer it to a child in their care. Schnittker (2003) argues that this perceived ‘non-compliance’ stigma causes doctors to adopt a ‘why bother’ attitude regarding prescribing Prozac to minority groups. The fact that racial stigmas affect the prescription rates of the drug highlights its racialized nature. To explain why African Americans are less likely to take Prozac, Schnittker discusses another racialized side of Prozac. During its clinical testing, minorities were significantly under represented as test subjects. In Schnittker’s (2003) research, he found that African Americans reported experiencing a considerably greater percentage of negative side effects of Prozac than Caucasians. This, in turn, causes African Americans to believe that Prozac would not be a beneficial drug for them to take, thus perpetuating the stereotype that Prozac is a drug for white people. Between Prozac being more widely prescribed and socially accepted by the white portion of society, it has become racialized as a drug only accessible for a specific race.

References

Application for updating fluoxetine age restriction for the treatment of depression from > 8 years to >12 years. WHO Mental Health: Evidence and Research. Geneva: World Health Organization. 1-28.

http://www.who.int/selection_medicines/committees/expert/19/applications/Fluoxetine_24_age_C.pdf

Best Buy Drugs: Using Antidepressants to Treat Depression. Report. Consumer Reports, 2013. 1-30. Accessed March 31, 2017. https://www.consumerreports.org/health/resources/pdf/best-buy-drugs/Antidepressants_update.pdf.

Federal Aviation Administration. U.S. Department of Transportation. “Press Release – FAA Proposes New Policy on Antidepressants for Pilots.” News release, April 2, 2010. Federal Aviation Administration. Accessed March 31, 2017. https://www.faa.gov/news/press_releases/news_story.cfm?newsId=11293.

“Fluoxetine.” MedlinePlus Drug Information. Accessed March 14, 2017. https://medlineplus.gov/druginfo/meds/a689006.html.

Gasbarre, April Dougal, David M. Walden, and Joyce Helena Brusin. “Eli Lilly and Company.” In International Directory of Company Histories, edited by Derek Jacques and Paula Kepos, 176-184. Vol. 109. Detroit: St. James Press, 2010. Gale Virtual Reference Library (accessed March 31, 2017). http://go.galegroup.com.proxy.library.vanderbilt.edu/ps/i.do?p=GVRL&sw=w&u=nash87800&v=2.1&it=r&id=GALE%7CCX1302700038&sid=exlibris&asid=7759665084c1d9eab76c68b7370dca82.

McLeod, Jane D., Bernice A. Pescosolido, David T. Takeuchi, and Falkenberg White Terry. 2004. “Public Attitudes Toward the use of Psychiatric Medications for Children*.” Journal of Health and Social Behavior 45 (1): 53-67. http://login.proxy.library.vanderbilt.edu/login?url=https://search-proquest-com.proxy.library.vanderbilt.edu/docview/201665106?accountid=14816.

Mollow, Anna. “”When Black Women start Going on Prozac”: Race, Gender, and Mental Illness in Meri Nana-Ama Danquah’s Willow Weep for Me.” MELUS: Multi-Ethnic Literature of the United States 31, no. 3 (2013): 67-99. doi:10.1093/melus/31.3.67.

Pratt, Laura A., Debra J. Brody, and Qiuping Gu. “Antidepressant Use in Persons Aged 12 and Over: United States, 2005–2008.” Centers for Disease Control and Prevention. October 19, 2011. Accessed April 01, 2017. https://www.cdc.gov/nchs/products/databriefs/db76.htm.

Prozac 20 mg Capsule. Digital image. Drakalogia. February 24, 2009. Accessed March 31, 2017. https://drakalogia.wikispaces.com/PROZAC 2.

Schnittker, Jason. 2003. “Misgivings of Medicine?: African Americans’ Skepticism of Psychiatric Medication*.” Journal of Health and Social Behavior 44 (4): 506-24. http://login.proxy.library.vanderbilt.edu/login?url=https://search-proquest-com.proxy.library.vanderbilt.edu/docview/201664706?accountid=14816.

Wong, David, Kenneth Perry, and Frank Bymaster. “The Discovery of Fluoxetine Hydrochloride (Prozac).” Nature Review Drug Discovery, September 2015. doi:doi:10.1038/nrd1821.