Overcoming the Dangers of
Prozac, Zoloft, Paxil, and
Other Antidepressants with
Safe, Effective Alternatives
Roughly 28 million Americans -- one in every ten -- have taken Prozac, Zoloft, 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 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 sensations in the brain, dizziness, nausea, and anxiety; and a decrease of antidepressant effectiveness in about 35 percent of long-term users. In addition, Dr. Glenmullen's research and riveting case studies 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 restore your spirits, keep your weight down, and make your sex life as vital 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 possible. The dangerous side effects, he points out, are caused by Prozac backlash, which is the brain's reaction to artificially elevated levels of serotonin.

Using vivid real-life stories from his work at Harvard, his private practice, and the latest medical research, Dr. Glenmullen explains the real role of serotonin in depression and challenges the popular, hypothetical notion of a "serotonin deficiency" allegedly corrected by the drugs. He relates the research history of Prozac and similar drugs, and 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 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 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.

[from the inside covers]

Prozac Backlash by Joseph Glenmullen, M.D.

About the Author

Joseph Glenmullen, M.D., a clinical instructor in psychiatry at Harvard Medical School, is on the staff of Harvard University Health Services and is in private practice in Harvard Square. He is the author of the widely applauded book Sexual Mysteries, a collection of ten fascinating cases ranging from sexual addictions to sexual abuse, with a foreword by Robert Coles, who likened Glenmullen's work to that of Freud. A graduate of Brown University and Harvard Medical School, Dr. Glenmullen lives with his wife and three children in Cambridge, Massachusetts.

[from the inside cover]

Table of Contents

Introduction: The Prozac Phenomenon   7


The Dangers of Prozac-Type
1. The Awakened Giant's Wrath: Risking Brain Damage  29
2. Held Hostage: Withdrawal, Dependence, and Wearing Off  64
3. Not Tonight, Dear -- I'm on Prozac: Sexual Dysfunction 106
4. Bones Rattling Like Tuning Forks: Startling New Information on Suicide and Violence 135


Balancing Medications with Alternative Approaches
5. Behind-the-Scenes Forces: Understanding the Prozac Phenomenon 189
6. Unraveling Depression: Stifled Anger and Sadness 233
7. Surmounting Anxiety: Training for Elevators, a Patient's Story 272
8. Conquering Addictions: Substances Abuse, Sexual Addictions, and Eating Disorders 310

Epilogue: Effecting Personal Change

Notes 339
Index 375

[from the hardbound edition]


"The all-purpose pill that guarantees a psychiatric quick fix has finally 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 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 only reliable approach to the problems of troubled men and women, each of whom presents a unique 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."

--Sherwin B. Nuland, M.D.,
Yale School of Medicine,
author of
How We Die and The Mysteries Within

"Joseph Glenmullen has done an outstanding job in portraying the real-life experiences of patients and using them to illustrate the scientific facts. If you really want to listen to Prozac, this is an eye-opening account that should not be missed."

--Thomas J. Moore,
George Washington University Medical Center,
author of Prescription for Disaster:
The Hidden Dangers in Your Medicine Cabinet

"Dr. Glenmullen has assembled from every possible source the clinical and scientific evidence that there are costs as well as benefits to Prozac and related drugs. He warns us that no one really knows the long-term consequences of these chemicals on the brain. His well-written book will surely be damned by the drug companies and their paid scientists. But Dr. Glenmullen, like many dedicated clinicians, has learned that if you keep on 'listening to Prozac,' you cannot help but recognize the danger signals."

--Alan Stone, M.D.,
Professor of Psychiatry and Law, Harvard University,
Former President of the American Psychiatric Association

"Dr. Glenmullen documents the carefully concealed dark side of these highly touted drugs and makes a strong case that alternative treatments yield equal benefits at much less risk. Provocative and hopeful, Prozac Backlash is a must-read for anyone on the drugs."

--Leon Eisenberg, M.D., Professor of Psychiatry,
Harvard Medical School

"In the tradition of Upton Sinclair's The Jungle, which exposed the meat-packing industry at the turn of the century, Prozac Backlash exposes the pill-packing of America's depressed at the century's close. Beautifully, clearly, and enthrallingly written, it is a courageous book and a must-read for every American."

--Candace B. Pert, Ph.D.,
Research Professor, Georgetown University School of Medicine,
author of
Molecules of Emotion: The Science Behind Mind-Body Medicine

"Dr. Glenmullen's book is a refreshing antidote to the limited information which has been available to the public. His book should be read by anyone on Prozac, Zoloft, Paxil, and other antidepressants; by anyone with a family member or friend on the drugs; and by those who prescribe them. Prozac Backlash is a gripping and disturbing account of psychiatry at the start of the new millennium."

--David Healy, M.D.,
author of The Antidepressant Era

"Prozac Backlash provides an authoritative and eloquent antidote to the pro-drug bias of modern psychiatry."

--John Horgan, journalist and author of
The End of Science and The Undiscovered Mind

[from the back cover]

Read more reviews of this book on the website:
Prozac Backlash:
Overcoming the Dangers of Prozac, Zoloft, Paxil,
and other Antidepressants with Safe, Effective Alternatives

Prozac Backlash on


To understand the side effects of these drugs, one needs to know a few basic facts of brain chemistry. Brain chemicals are called neurotransmitters. Of the more than a hundred neurotransmitters now known, three are important for our purposes: serotonin, adrenaline, and dopamine, popularly referred to as the brain's "feel good" neurotransmitters. Whereas earlier mood brighteners like cocaine and amphetamines boost all three of these neurotransmitters, the Prozac group were hailed as a breakthrough because they are "selective" for serotonin. This selectivity gives the impression that serotonin is localized in a depression center in the brain. If a depressed person's serotonin is low, the impression given is that the drugs top it up in a safe, targeted manner.

This impression does not match reality, however. Serotonin is one of the oldest neurotransmitters in the evolution of life forms. In humans only about 5% of serotonin is found in the brain. The other 95% is distributed throughout the rest of the body. The majority is in the gastrointestinal tract, where serotonin modulates the rhythmic movements kneading food through the stomach. In the cardiovascular system, serotonin helps regulate blood vessels to control the flow of blood. Serotonin is also found in blood cells and plays an important role in clotting. In the reproductive system, serotonin's influence on the genitals accounts for its sexual effects. Serotonin plays a significant role in controlling a host of hormones that regulate a panoply of physiologic processes.

In the human brain, serotonin is one of the chemicals by which brain cells signal, or communicate with, one another. Serotonin nerves originate in the deepest, oldest part of the brain, called the brain stem. But while serotonin nerves originate here, they radiate diffusely, penetrating virtually every part of the brain. Efrain Azmitia, a professor of biology and psychiatry at New York University and one of the world's leading authorities on serotonin, says, "The brain serotonin system is the single largest brain system known and can be characterized as a 'giant' neuronal system."

During gestation, this giant system orchestrates some of the development of the brain, regulating the maturation of the brain's architecture. No wonder this vast network then has global modulatory effects throughout the nervous system. Says Azmitia, "Serotonin has been implicated in sleep, aggression, sexual activity, appetite, learning, and memory to name but a few behaviors altered by serotonin drugs or damage to the 5-HT [serotonin nerve] fibers....The broad range of functions complements the extensive anatomy of the serotonin neurons [brain cells]."

So while pharmaceutical companies have marketed Prozac, Zoloft, Paxil, and Luvox as "selective" for serotonin, serotonin is anything but selective in its widespread effects. There is, in fact, no known depression center in the brain. Rather, the drugs have global effects owing to serotonin's vast influence.

The illustrations on pages 18 and 19 show how Prozac-type drugs are thought to boost serotonin neurotransmission. Each serotonin nerve branches into a web of hundreds of thousands of delicate tentacles that reach out to communicate with other nerves. At the ends of these branches, the signaling nerve releases serotonin as a chemical messenger that travels across a microscopic space and attaches to receptors on the receiving nerve. The arrival of serotonin completes the signal to the receiving cell.

After a signal has been sent, the cell from which it originates cleans up unused serotonin by reabsorbing it in a process called "reuptake." Reuptake keeps signals crisp, terminating them in a timely fashion, which prevents lingering serotonin from continuing to stimulate the receiving cell. Prozac-type drugs inhibit -- or block -- reuptake, thereby boosting the level of serotonin, prolonging serotonin signals in the brain.

In the most cutting-edge research, the current and formerly popular antidepressants -- including cocaine, amphetamines, and the Prozac-group -- appear to boost neurotransmitters beyond levels achieved under ordinary circumstances. Barry Jacobs, a professor of neuroscience at Princeton University, wrote in the December 1991 issue of the Journal of Clinical Psychiatry that most "external manipulation" of the system by drugs creates serotonin levels "beyond the physiological range achieved under [normal] environmental/biological conditions." Boosting serotonin to this degree "might more appropriately be considered pathologic, rather than reflective of the normal biological role of 5-HT [serotonin] [italics added]."

Similarly, psychiatrist Steven Hyman, director of the National Institute of Mental Health, wrote in 1996, "Chronic administration of psychotropic drugs [i.e., drugs with psychological effects] creates perturbations [imbalances] in neurotransmitter function that likely exceed the strength and time course of almost any natural stimulus." This "hyperstimulation" triggers "compensatory" reactions in the brain in its efforts to achieve "a new adapted state which may be qualitatively as well as quantitatively different from the normal state."

Most recently, neuroscientists have learned not only that the effects of a single neurotransmitter like serotonin are extremely widespread but that different neurotransmitters do not function independently of one another. Critical systems like serotonin, adrenaline, and dopamine are linked through complex circuitry. Dramatic changes in one, like boosting serotonin, can trigger compensatory changes in the others.

Chief among the brain's reactions to artificially elevated serotonin levels is a compensatory drop in dopamine. Drugs producing a dopamine drop are well known to cause the dangerous side effects that are now appearing with Prozac and other drugs in its class. We simply did not know that serotonin boosters had these powerful secondary effects on other neurotransmitters when they were introduced. At the time they were an utterly new class of medications whose long-term dangers were unknown. Doctors and scientists are just beginning to understand the connections between the serotonin and dopamine systems in the brain that are thought to be responsible for the drugs' severe effects. But with earlier classes of drugs, the brain damage that can result is slowly progressive and often silent, and only manifests itself once it is severe. A critical variable determining the degree of damage appears to be total cumulative exposure to the drugs.

Thus, even the highly touted "selectivity" of the Prozac group is an illusion. In fact, the extreme emphasis these drugs place on serotonin may be a liability, because changes in serotonin levels can trigger secondary, or indirect, changes in dopamine. I call the compensatory reactions of the brain to these serotonergic drugs "Prozac backlash." Here I am using the word "Prozac" generically to stand for the whole group of closely related drugs, since Prozac is the first and best known in the class. In patients on the other drugs, it could as easily be called by names like "Zoloft backlash" or "Paxil backlash." Experts believe this backlash is responsible for the severe side effects emerging with the drugs.

Prozac Backlash:
Overcoming the Dangers of Prozac, Zoloft, Paxil,
and other Antidepressants with Safe, Effective Alternatives

pages 16-18, 20

Psychopharmacology rests on a "disease model" of psychiatric symptoms. This is the application of an extreme medical or biological model to psychological syndromes. In all likelihood a few severe psychiatric conditions such as schizophrenia, manic depressive illness, or psychotic depression have a strong biological component. But to treat all psychiatric symptoms as though they were exclusively biological is unaccepable reductionism.

Medical and psychiatric patients come to see doctors because of symptoms. But symptoms in and of themselves are not necessarily indicative of a disease. In medicine, strict criteria exist for calling a condition a disease. In addition to a predictable cluster of symptoms, the cause of the symptoms or some understanding of their physiology must be established. This knowledge elevates a diagnosis to the status of a recognized disease. For example, "fever" is not a disease, it is merely a symptom. In the absence of known cause or physiology, a cluster of symptoms that one sees repeatedly in many different patients is called a syndrome, not a disease.

Psychiatry is unique among medical specialties in that all of its diagnoses are merely syndromes, clusters of symptoms presumed to be related, not diseases. We do not yet have proof either of the cause or the physiology for any psychiatric diagnosis. This is why the official names of psychiatric diagnoses in the American Psychiatric Associations's Diagnostic and Statistical Manual (DSM) -- such as major depressive disorder, obsessive compulsive disorder, or manic depressive disorder -- use the term "disorder." Here the word "disorder" is being used for syndrome. The diagnoses are called disorders because none of them are established diseases. We do not yet have a major depressive disease or even a manic depressive disease.

In the absence of any verifiable diseases, in recent decades, psychopharmacology has not hesitated to construct "disease models" for psychiatric diagnoses. These models are hypothetical suggestions of what might be the underlying physiology -- for example, a serotonin imbalance. Through the 1970s and 1980s, a curious circularity invaded psychiatry, as "diseases" began to be "modeled" on the medications that "treat" them. If a drug elevated serotonin in test tubes, then it was presumptuously argued that patients helped by the medication must have serotonin deficiencies even though we lack scientific proof for the idea. In the past decade, as part of promoting the new antidepressants, these "disease models" were presented to patients as if they were established facts. Writing in the November 1997 issue of the Archives of General Psychiatry, psychopharmacologist Lewis Judd of the department of psychiatry at the University of California at San Diego described depression as "a disease of the brain." Patients are often explicitly told they have such a disease, usually to justify treating them with medication. But when one looks closely, all the disease models are built on three pseudoscientific cornerstones: superficial checklist diagnoses, putative "biochemical imbalances," and alleged genetic determinism.

Prozac Backlash:
Overcoming the Dangers of Prozac, Zoloft, Paxil,
and other Antidepressants with Safe, Effective Alternatives

pages 192-193

[from the hardbound edition]

Read more about this book on the website:
Prozac Backlash:
Overcoming the Dangers of Prozac, Zoloft, Paxil,
and other Antidepressants with Safe, Effective Alternatives

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Overcoming the Dangers of Prozac, Zoloft, Paxil,
and other Antidepressants with Safe, Effective Alternatives

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Sexual Mysteries: Tales of Psychotherapy

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