Paragraph one reads: "What is with the over-prescription of anti-depressants? Is everyone in the United States depressed or just the ones with good drug coverage? Recently, I was talking with my co-workers and friends about other friends and family members on Prozac, Paxil and others. Many of us told stories about bizarre behaviors, a seeming "loss of conscience," sexual acting-out . . . just general nuttiness."

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Paxil, Prozac are generally safe
Milwaukee Journal Sentinel (WI)
August 9, 2004
Author: JULIE MITCHELL
Estimated printed pages: 3

Q. What is with the over-prescription of anti-depressants? Is everyone in the United States depressed or just the ones with good drug coverage?
Recently, I was talking with my co-workers and friends about other friends and family members on Prozac, Paxil and others. Many of us told stories about bizarre behaviors, a seeming "loss of conscience," sexual acting-out . . . just general nuttiness.

Is it possible to abuse these drugs? Does anyone really know how these drugs work? Don't we all get the blues from time to time and do we really need a pill to "feel better?

I know these drugs have been a literal lifesaver for some, but for others, these drugs just seem to wreck havoc on those around them.

A. The newer class of anti-depressants, called SSRIs, includes a number of medications including the ones you mentioned. They work by modifying the pathway of one of the brain's neurotransmitters: serotonin. I would agree with your suggestion that we don't "really" know how they work any more than we know how the brain composes thoughts or feelings.

These drugs are generally safe, with the latest warning to watch for worsening depression or suicidal thoughts on first starting the medication. And some experts do not think this warning is necessary: They propose that suicidality is a risk in people who first start SSRIs simply because people are usually started on SSRIs when they have reached a low point in their depression and have sought a doctor's consultation. The established adverse effects in SSRIs include insomnia, agitation, sleepiness, nausea and headache, but not bizarre behavior.

These medications do improve depressed mood in many people, and I have known them to be extremely useful. Depression is difficult to "measure"; that is, the diagnosis of depression is made by a health care provider putting together a constellation of symptoms, the social situation and the description of day-to-day function. Because of this and because the impact of depression is so individual, statistics are hard to give. That said, about 50% to 60% of people respond to their first anti-depressant after about two weeks of use. About 90% of people have better moods given more time on a particular medication or after a change in anti-depressant medication.

I wonder if the bizarre behaviors you notice are more related to a depressed person trying to cope rather than a direct effect of the medication. If you are concerned about someone close to you, you may suggest they seek psychotherapy or a specialist's consultation. Depression can be treated without drugs.

Q. I am 80 years old and for 50 years I have had constipation off and on. Recently, after a surgery, the nurse recommended I take in 25g to 30g of fiber every day. Now I feel great!

Please tell your readers that fiber is a good option to manage constipation. (Here's a good Web site: www.wehealnewyork.org/healthinfo/dietaryfiber/)

A. I agree: Fiber in your diet can help bowels stay regular. The Web site you cite has good information on finding high-fiber foods, but you can also read product nutrition labels.

Good foods are fruits, vegetables and whole grains. Do remember to change your diet slowly: Fiber can cause bloating and gas, particularly if you add dietary fiber too quickly.

Q. I spent two years in China and one of my observations was that Chinese did not put salt on the table. They used vinegar. Vinegar plus garlic, sometimes with a touch of soy or hot sauce, but most often just vinegar was used on everything, especially meat and "pot stickers."

You recently wrote about sodium in the American diet. Think of the difference it would make if Americans used vinegar and garlic instead of salt!

A. Another good idea! It is useful to borrow healthier traditions from other cultures.

Q. In your March column, Dr. Olds stated that offal was used as a binder for hamburgers in "some fast food" restaurants. I thought offal was banned from the human food chain because of the concerns about mad cow disease.

Does Dr. Olds know which fast-food restaurants? I want to know where to eat my hamburgers.

A. The U.K. did ban lamb's brain, but offal, also called "variety meats" and which includes animals' brains and nervous systems, is still considered a gourmet delicacy in some circles and eaten out of necessity in others. So, restaurants are not required to report the exact contents of their hamburgers. Maybe you could ask the restaurants directly, and let them know that offal matters to you.

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Julie Mitchell is an assistant professor of medicine at the Medical College of Wisconsin. Send questions to her at: Medical College of Wisconsin Physicians & Clinics, 9200 W. Wisconsin Ave., Milwaukee WI 53226 or via e-mail at drjulie@mcw.edu. Copyright Medical College of Wisconsin.
Edition: All
Section: G Health and Science
Page: 2
Column: Ask Dr. Julie
Copyright 2004 Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)
Record Number: 2004080906210809

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Paxil, Prozac are generally safe