QUESTION:
Dear Dr. Heller,
I have been on Prozac twice. The first time was for six months back in '97, then I went back on it again in '99 for just over a year. Both times were with 20 mg. The 2nd time I went on it the 20 mg did not have the same 'kick' as the first. I have now been off of Prozac for five weeks and am feeling quite good actually. I've increased my potassium intake and started taking colloidal minerals ( I seem to have a lot more energy now ).
What bothered me about Prozac was that it's not 'real'. It's more an artificial happiness (this may be hard to understand if you've never been on it). Perhaps think of the difference between aspartame and sugar - very close but not quite like sugar.
Now the fact that I was not getting the kick the second time says I needed a larger dose. It seems eventually your gonna end up with having to go up in dosage and then finally, hitting a wall, then having to find another drug. And so on & so on.
Now maybe I will end up back on Prozac....who knows, but I think retraining your brain is really smart and if need be I would try St. John's Wort first. What are your thoughts on "natures naturally occurring Prozac"? There seems to be very good reports from German Doctors regarding it.
ANSWER:
St. John's Wort (hypericum) can help many individuals with a bout of mild
depression. It has lots of drug interactions that make it relatively risky. Eating healthy
and taking vitamins is a great idea.
There are many genetic "happiness levels" - where some individuals are born
jolly and others relatively unhappy. Prozac has the dramatic effect of altering that
genetic phenomenon. It used to be called "depressed personality disorder", and I
refer to it as "fractured enjoyment" in "Biological Unhappiness."
Your comment about it being an "artificial happiness" is an issue that has
generated debate in medical circles. The book "Listening to Prozac" by Dr. Peter
Kramer will give you a good overview of the medical community's thinking in this
regard. The use of Prozac for some is described as "cosmetic
psychopharmacology." St. John's Wort would have the same "artificial
happiness" issue as Prozac, however. Just because a substance is natural doesn't
mean it's not a drug - examples include aspirin, penicillin, marijuana, alcohol,
cocaine and narcotics. Wearing sunscreen is artificial because it allows an individual to
spend time in the sun who ordinarily would get a severe burn. Likewise, fixing a clubbed
foot in a child or removing a cataract in an older person would be medically altering a
natural condition to make the individual have a happier and more enjoyable life.
In my experience Prozac doesn't usually need a steady increase in dose unless high
doses were needed in the first place. The so-called "Prozac poop out" is usually
the BPD developing dysphoria (anxiety, rage, depression and despair). Making all the
treatable diagnoses and treating them is crucial.
