The power of Prozac

0 Comments | Insight on the News, Sept 14, 1998 | by Michael Rust

Serotonin-boosting mood enhancers have been a booming industry for more than a decade, and critics of the `miracle drugs' just may be harboring a bias about mental illness.

It has been more than a decade now since the antidepressant Prozac was unleashed on the marketplace, proving a boon both to chronic depressives and stockholders in drugmaker Eli Lilly. During those 10 years, antidepressants changed the way Americans think about themselves -- in more ways than one. The only remaining question, one to which there is no easy answer, is whether this change of heart is something to be depressed about.

Certainly, there is a need for antidepressants. One recent U.S. study found that the annual cost of depression as a result of early death, lost workdays and lowered productivity is at least $43 billion. At the same time, the worldwide market for antidepressants has boomed. Prozac, Zoloft and Paxil account for at least $5.5 billion in sales each year. The existing drugs typically take up to six weeks to take effect. The industry is racing to see who will come up with a faster-working antidepressant.

Prozac, the drug that launched a thousand headlines, is a selective serotonin re-uptake inhibitor, as are Pfizer's Zoloft and SmithKline Beecham PLC's Paxil, the other leading antidepressants. (In the last two years, Bristol-Myers-Squibb's Serzone and American Home Products Corp.'s Effexor also have entered the market.) These drugs increase the brain's level of serotonin, a neurotransmitter -- in essence, a chemical transmitter -- that helps brain cells communicate with one another. Higher levels of serotonin lead to better moods. The newer drugs are dramatically safer than previous generations of antidepressants and have achieved a kind of cultural status enjoyed by few prescription remedies -- although in recent months the anti-impotence drug Viagra has dominated the news.

One young entrepreneur has marketed jewelry shaped like Zoloff and Paxil (Lilly refused to give permission). And new uses for the drugs pop up in the oddest places -- even in the aquaculture industry. While Prozac and other antidepressants have been known to blunt the sex drive in humans, a recent study by a biologist, Peter P. Fong of Gettysburg College, shows that Prozac triggers orgasm in male and female mussels within a minute of their exposure to the drug. Mussels rely on serotonin to release their sperm or eggs, and mussel farmers added the hormone to their waters whenever a new generation was needed. Fong's experiments showed that tiny doses of the antidepressant were effective in spurring mussel reproduction. In fact, he estimated that a dollar's worth of Prozac will convince more than 1,500 male mussels to spawn, compared with only 11 by using a dollar's worth of serotonin.

The tablets now are part of a trade controversy. In the People's Republic of China, or PRC, a legal sophistry has allowed Chinese drug manufacturers to make "knockoffs" -- exact pharmacological replicas of Prozac -- and sell them in China. Eli Lilly & Co. has requested help from the U.S. government, and President Clinton reportedly raised the issue during his recent summit with Chinese President Jiang Zemin. The Indianapolis-based Eli Lilly even is using the fast-evolving court system on mainland China to try to shut down its rivals. Patents protect Prozac elsewhere in the world until at least 2003. Under Chinese patent law, many Western pharmaceuticals such as Prozac are fair game for local companies to make and market while administrative-protection applications are pending. Several Chinese companies are making and marketing Fluxotine, Eli Lilly's patented Prozac compound; since they bypass the expense of research and development, they easily can undercut the U.S. companies.

When Eli Lilly saw Prozac's dominant market share threatened by new competitors such as Zoloft and Paxil, the company responded with attention-grabbing two-page ads in 20 national publications. On one page, a crayon-drawn rain cloud floats above the slogan, "Depression hurts." The facing page features a sun shining upon the words, "Prozac can help." In the world of pharmaceutical marketing, this was certainly a switch. The pitch was directed at potential patients more than prescribing doctors, although the companies have bombarded physicians with promotional materials as well.

Some claimed to be offended by these ads, but others say this discontent is aimed at much more than the ads --or even the drugs. "Certainly, Prozac's big business, so it's an easy target," says Jenna Wallace, a spokeswoman for the National Foundation for Depressive Illness, a New York-based clearinghouse for information about depression. "But we haven't seen as much of the same outcry over Viagra."

In fact, even as this generation of antidepressants enters its second decade, they are threatened both by those who decry the drugs as a symptom of a self-absorbed, self-indulgent culture and those who embrace the antidepressants as not just useful tools but harbingers of a new golden age.