Paragraph 20 reads: "For my father, Prozac finally lost its sheen after a few years. "It dawned on me that Prozac was doing no good," he says. Coming off it, the erratic behaviour stopped - as did the suicidal tendencies. Climbing up rock faces on holiday, swimming in dangerous seas, driving down motorways at 120mph, that feeling of infallibility coupled with mood swings - all disappeared. Too nervous to go "clean", warned by the doctors not to give up altogether, he tried one final antidepressant, Nefazedone [Serzone], but says it made him feel hostile."
When her father tried to kill himself, Claire Seeber was desperate to find the cause of his distress. Was it his depression that was making him suicidal, or the Prozac he'd been given to treat it?
25 January 2005
It's scary how quickly life can change. One summer's afternoon a few years ago, I idly answered my office phone. Flatly, succinctly, a voice told me that my father had just overdosed. He had tried to kill himself.
The busy room went into slow motion. My dad was in the hospital - alive. He hadn't even taken all that many pills, but he was very unwell. Don't come today, they said, he's barely conscious, too groggy to talk. In one moment, my life turned on its head.
At the crack of dawn the next day, my sister and I drove down from London, bombing through the Sussex lanes to the house by the sea where my father now lay. We needed to get there fast, yet something made me want never to arrive. The shock of seeing one of my parents in that state is something I'll never forget. Child-like, he was tucked up in bed, head peeking from the blanket. I wanted to run screaming from the room - I am the child, not you, an inner voice kept saying.
Delirious and croaky, my father lay there, totally the victim, consumed by - what? Self-pity, sorrow? There wasn't much to say other than: "Why did you do it?" And later, more regularly: "Are you going to do it again?" and, at worst, a plea: "You won't, will you?"
The trigger? In the throes of his second marriage meltdown, my father began suffering a debilitating depression, and so our old family doctor prescribed a "wonder drug" called Prozac, which had been introduced in the United States in January 1988. It was still relatively new in the UK (this was 1997), and not much was known about it, other than it was supposedly a "cure-all" antidepressant.
In an effort to patch things up, my father and stepmother moved to Sussex. Still unsettled and depressed, his Prozac dose was doubled. A hefty dose for something still so new, we thought, and for someone with no history of depression. Oh, it was a marvellous thing, my father said; Prozac was all that kept him going. But the marriage failed anyway, he was forced to leave his home - and on the double dose, suddenly the suicidal urges became attempts. That's when I got the first phone call.
Unwanted divorce would affect anyone badly, but my father began acting in a most peculiar and unprecedented way. On the one hand, he apparently wanted to die. Incessant talk of death was coupled with a quite new self-hatred. It would be better to be dead, he'd say, he felt like a burden.
Yet, perversely, the Prozac was also giving him a new lease of life, according to him. He'd found new depths to his nature; he was better-tempered, more able to interact with strangers. At times he was worryingly open about his feelings (there are some things children, however adult, need never know about their parents). From where we stood, it seemed he'd been prescribed some strange party drug, a kind of legal Ecstasy. The two facets of Prozac just didn't sit comfortably together - for all his apparent buoyancy, he was also suicidal. Bizarrely reckless, he suddenly became prone to doing weird and not very wonderful things.
Just when we thought it was safe to sleep again, he vanished and was found, in his pyjamas, on the edge of Beachy Head. Months later, when we thought he'd turned a corner, he made the worst attempt of all, downing 100 paracetamol, and ending up in hospital again. Paracetamol often doesn't kill you straight away - it's liver failure days later that will do it. The doctors administered an enzyme and monitored his liver for three days, warning that it was touch and go.
I took up smoking again. Always on the verge of panic, I expected the phone to ring at any hour with terrible news. How could we stop my father from killing himself if he really felt like it? Short of being his keepers, we simply couldn't. I found it hard to cope with the intensity of fear I felt. I felt very sorry that my father was so unhappy, but simultaneously I felt angry that he was inflicting this on us. Anger would then be followed by overwhelming guilt.
Perhaps the most painful thing about parental suicide is the realisation that you, the children, are inadequate. We simply weren't enough at this point to inspire our parent to live. We hadn't lived with my father since we were small, and although we'd seen him regularly, we didn't know him all that well. This was proving to be a ridiculously steep learning-curve, for now my stepmother had left, there was only us (his close family being abroad).
We wondered whether he was really suicidal, or just prone, because of the Prozac, to reckless acts. Cries for help or genuine suicidal urges; whatever the impulse, the Prozac - more than the depression - was changing our dad into someone else. One final suicide attempt involving sleeping-pills and whisky - and now we were desperate. Who could we turn to for help? I rang the London doctor to ask about the Prozac. Why was my father being prescribed massive doses of a drug that just made matters worse? This middle-aged doctor, whom I'd known for years, was hostile. It was the best thing for my father, he said, and that was that.
We were worried that my father drank quite heavily with it. The alcohol on top of Prozac seemed to trigger the overdoses. My own young doctor looked Prozac up - she, too, still knew very little about it. She couldn't find anything about any of the side effects we were convinced we were seeing. Meanwhile, his new doctor down in Sussex refused to suggest that my father came off the drug; he couldn't say what would happen if he did.
What concerned us most was that all these doctors seemed to know so little about Prozac, and yet refused to admit that it could do any harm. They stood united on the fact that he should stay on it, while we were convinced it was changing him irrevocably.
Eventually, my sister and I visited Depression Alliance in London. The relief we felt at being listened to was immense; finally, we weren't simply fobbed off with how wonderful Prozac was. Obviously, what works for one person won't necessarily work for another. But to prescribe something so new to someone with no history of depression seemed suspect to us. Amelia Mustapha of Depression Alliance says that for the depressed, "a range of options is vital. In the early days, Prozac was seen as a miracle cure, but different people need to try different things to find what works. The partnership between patient and doctor is key. Whatever is prescribed then needs to have a view taken on it. Doctors must be aware that drugs like Prozac can augment suicidal thoughts in some."
Depression Alliance would like to see GPs given more training to deal with depression. Although apparently one in three patient consultations involves depression, there are still not enough resources to provide alternatives to medication (such as NHS counsellors).
There has been controversy over Prozac from early on, and today it's no longer hailed as a "wonder drug". Last month, it was alleged that the Prozac manufacturer Eli Lilly was aware of the increased likelihood of suicide, among other side effects: "[A] 1988 document indicated that 3.7 per cent of patients attempted suicide while on the blockbuster drug, a rate more than 12 times that cited for any of four other commonly used antidepressants," the news network CNN reported on 5 January this year.
Also in December last year, the National Institute of Clinical Excellence (Nice) reported that British GPs grossly overprescribed antidepressants such as Prozac, and suggested that the now well-known risks (such as suicide, anxiety, insomnia and headaches) of such drugs outweigh their benefits, especially for milder forms of depression.
For my father, Prozac finally lost its sheen after a few years. "It dawned on me that Prozac was doing no good," he says. Coming off it, the erratic behaviour stopped - as did the suicidal tendencies. Climbing up rock faces on holiday, swimming in dangerous seas, driving down motorways at 120mph, that feeling of infallibility coupled with mood swings - all disappeared. Too nervous to go "clean", warned by the doctors not to give up altogether, he tried one final antidepressant, Nefazedone, but says it made him feel hostile. (Recent reports suggest it might be withdrawn altogether because of concerns about liver problems.)
Over time, he has found that St John's Wort works best for him. Perhaps its "natural" character makes it more palatable. It makes him feel better in himself, he says, so it makes depression easier to cope with. He has also found new friends to talk to and new outlets for his energy - new work, for instance, not to mention three young grandchildren.
Now, he says: "I feel I was very much sold Prozac. By the doctor, by stuff I read saying it was great. It made me feel more approachable, more open. I didn't realise that it made me completely reckless." He says the original prescribing doctor didn't even know the side effects; he actually asked my father to report back on them.
Would he have made the suicide attempts without Prozac? "No. I would never have had the nerve to do it without the drug. Generally, I love life." Suicide hasn't been an option since he quit, though my sister and I are left for ever aware of his vulnerability. Phone calls in the middle of the night still make me nervous. Please God we never go through that again.
THE 'WONDER' DRUG
* Prozac was the first in a class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs), and has so far been used by around 50 million people worldwide.
* SSRIs increase the supply of serotonin to the brain. An imbalance in serotonin is an important factor in depression.
* The Department of Health last month advised doctors to be careful when prescribing the drug, after it was found that four out of five GPs were over-prescribing Prozac.
* For many patients, the effects are positive: improved confidence and a better outlook on life. Negative side effects include nausea and anxiety.
* The US Food and Drug Administration is to review documents that reportedly link Prozac and suicide.