_Let Them Eat Prozac_ -- David Healy
Again, provocative title, but solid information. Healy also displays an inappropriate sense of humor on his blog.
This is both a history and a personal memoir. Healy learns as he goes.
One of the more interesting nuggets is a small double-blind study of healthy volunteers he conducted -- the volunteers being largely health professionals, including nurses and psychiatrists.
pgs 174-190:
Half of the people were given Zoloft (sertraline) , half reboxetine. Then the drugs were switched. What was interesting to me is that there were marked preferences among the volunteers: some felt good on one drug, some felt horrible, and vice versa.
Two healthy volunteers became suicidal.
The result seemed to agree with a study by Joyce and Mulder showing that people's response to an AD can be predicted somewhat by a personality test.
I think it might be this one:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104887/
Some other nuggets:
Chasing the question of whether Zoloft caused emotional blunting, half the group said it had given them a "nothing bothers me" feeling. Reactions were split about this: Some liked the effect; others found it made them emotionally dead. Reboxetine, in contrast, didn't seem to make anyone feel indifferent.
and, on the issue of suicidality:
It seems that a small but significant number of people -- who weren't suicidal before -- become suicidal on SSRIs, especially at the beginning of treatment.
Now, there is (imo, absolutely terrible) advice from some quarters to
stay on the med at the beginning -- that this will pass. It seems that the proper question should be whether someone who has a bad reaction to a psychoactive drug should be on that drug at all to begin with.
Less than 40% of people are "compliant" (an ugly word) with SSRI medications: They stop taking them fairly quickly.
When the first studies of Prozac were done, it failed most tests. It was considered to be a poor antidepressant by the Germans and some others. Also, it was considered necessary to give people a benzo at the same time at the beginning of treatment to calm down the agitation caused by the drug.
It also seems that the statistics on suicide vary hugely. If you take the suicide rate of people hospitalized for depression, it's very high, and this might be considered justification for drug treatment. But if you calculate the rate based on people who were not hospitalized, it's much lower. This may seem obvious, but when different groups are arguing, they may use one set of numbers or the other.
It seems that there is an agitation produced by Prozac that is quite distinct from their depression.
Anyway, this is a slightly rambling, somewhat blow-by-blow book, but full of interesting information.
some reviews:
http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=2744&cn=158
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192386/