Micro-Macro Connection

The Pharmaceutical Personality

Prozac arrived on the scene in 1987 as a new antidepressant drug. Almost as soon as it hit the market, it was being hailed as a miracle cure. Not only was it effective and easy to prescribe, it was relatively free from the weight gain, low blood pressure, irregular heart rhythms, and other side effects common with earlier antidepressant drugs. By 1990, Prozac had become the top-selling antidepressant in the world, a position it held until 2000. At its peak, Prozac brought in $3 billion in annual revenues (Zuckoff, 2000). Sales have dipped recently as cheaper, generic versions have entered the market. Nevertheless, Prozac and chemically similar antidepressant drugs such as Zoloft, Paxil, Celexa, and Wellbutrin earn $8.7 billion a year in U.S. sales alone (“Top antidepressant drugs,” 2015). GlaxoSmithKline spent more money—$91 million—advertising Paxil in one year than Nike spent advertising its top shoes (C. Elliott, 2003). At one point, 8.5% of the entire U.S. civilian, noninstitutionalized population had a prescription for an antidepressant (Stagnitti, 2005).

Antidepressants quickly grew to be more than just treatments for depression, however. They are now regularly prescribed for people with eating disorders, obsessive-compulsive disorders, anxiety disorders, social phobias, obesity, gambling addiction, and family problems. A version of Prozac called Sarafem is prescribed for women complaining of premenstrual difficulties. Some people use antidepressants to enhance job performance, improve their alertness and concentration, overcome boredom, think more clearly, become more assertive, or get along better with their mates.

Clearly, the therapeutic realm of antidepressants has expanded beyond clinical depression to include more of what were once thought of as ordinary life stresses. In his influential book Listening to Prozac (1997), psychiatrist Peter Kramer—an avid proponent and energetic prescriber of the drug—argues that Prozac can (and perhaps should) also be used to remove aspects of our personality we find objectionable. He likens the use of Prozac to overcome undesirable psychological traits to the use of cosmetic surgery to overcome undesirable physical ones.

Many people who have benefited from antidepressants describe them in adoring, almost worshipful terms. They weren’t healed; they were transformed. Shy introverts report turning into social butterflies, mediocre workers turn into on-the-job dynamos, the bored become interested and alert—even the unattractive begin to feel more beautiful. Some people see drugs like Prozac as nothing short of a divine creation:

As my husband and I watched the results of Prozac, we knew that the medication was God’s gift to us. Breakthroughs . . . like Prozac are evidence of His grace. I now feel God’s love for me as I never have before. . . . I believe that it is helping me be more true to the person God created me to be. (quoted in Tapia, 1995, p. 17)

According to Kramer (1997), his patients feel “better than well” shortly after they begin taking the drug. They report improvement in their popularity, business sense, self-image, energy, and sexual appeal. One patient was having trouble at work and had recently broken up with her boyfriend. Kramer prescribed Prozac. Within weeks, she was dating several men and handling her job demands smoothly. She even received a substantial pay raise. Convinced that the drug had created these improvements in her life, she happily referred to herself as “Ms. Prozac.”

Antidepressants are appealing for economic reasons, too. Because traditional psychotherapy (patients talking to therapists about their problems) is time consuming and expensive, efforts to cut health care costs work against its use. A psychiatrist can earn $150 for three 15-minute medication visits compared with $90 for a 45-minute talk therapy session (G. Harris, 2011c). Furthermore, many health care plans limit or exclude extensive talk therapy in their coverage, thereby indirectly encouraging greater use of antidepressant drugs. According to one government survey, only about 11% of psychiatrists provide talk therapy to all their patients, even though recent evidence suggests that such an approach may be as good as or better than drugs in the treatment of depression (G. Harris, 2011b).

Despite claims by some that antidepressants increase suicidal tendencies, they’ve certainly helped tens of millions of people in serious need. But their popularity raises fundamental sociological questions about the role all sorts of prescription drugs ought to play in everyday life. Critics fear that antidepressants—as well as other drugs that can modify character—are aimed not just at “sick patients” but at people who already function at a high level and want enriched memory, enhanced intelligence, heightened concentration, and a transformation of bad moods into good ones. In a fast-paced, achievement-oriented society such as the United States, the motivations for gaining a competitive edge—whether in school, on the job, or in interpersonal relations—are obvious. Those who earn higher grades, sell more cars, or come across as more charming and attractive can reap enormous financial and social benefits. At high schools around the country, pressure over grades and competition to get into college have driven more and more students to use stimulants, like Adderall, Vyvanse, and Concerta. As one columnist put it, in competitive high schools, the use of such drugs to boost grades has gone from “rare to routine” (Schwarz, 2012b, p. A1). More than one in three college students admit to using such drugs to improve their academic performance (“Adderall Statistics,” 2012). And there is growing evidence that the illicit use of stimulants is spilling into the workforce. One Pennsylvania dentist prescribed herself Adderall for years, saying that it enabled her to see “15 patients a day rather than 12” (quoted in Schwarz, 2015, p. 17).

But once people begin to use a drug to chemically enhance performance, those who do not use the drug—whether for reasons of principle or because they can’t afford it—risk losing out and becoming the less rewarded and less valuable members of the community (President’s Council on Bioethics, 2003). Would we, as a society, have to resort to legal regulation—much like the ban on athletic performance enhancers such as anabolic steroids—to prevent a desperate race to keep up?

On a more profound level, if we can use existing pharmaceutical technology to chemically eradicate sadness and despair, why would anyone ever put up with emotional discomfort? In the past, people simply assumed that misery and suffering were part of the human condition. Just as physical pain prevents us from burning ourselves if we get too close to a fire, perhaps mental pain, too, serves a purpose, such as motivating us to change life situations that are getting us into trouble. There’s the spiritual element as well: “One reconceives sadness as sickness only by emptying it of psychic or spiritual significance and turning it into a mere thing of the body” (President’s Council on Bioethics, 2003, p. 261).

But people today are more inclined to believe they have a right not to be unhappy. Sadness is inconvenient and prevents us from reaching our potential. And if there’s a drug to get rid of it quickly and cheaply, then why not use it? And it’s not just in the form of pills. Researchers in Japan recently found that prefectures with higher naturally occurring levels of lithium in their water—a mineral that helps balance mood swings—have lower suicide rates than other areas (Ohgami, Terao, Shiotsuki, Ishii, & Iwata, 2009). This finding has led some to speculate that perhaps adding lithium to water supplies can build up a community’s resistance to depression, not unlike adding fluoride to water supplies has reduced levels of tooth decay.

Mood-altering drugs have not yet completely redefined society. Quite possibly depression, unlike polio or smallpox, will never be essentially wiped out. But the technological possibilities not only of antidepressants but of brain-scanning techniques, genetic modification, and drugs as yet unknown raise important issues about the role of medicine in defining deviance, controlling behavior, constructing personality, and ultimately determining social life and the culture that guides it.