Analysis Prozac

Description of Method. Fluoxetine, whose structure is shown in Figure 12.31a, is another name for the antidepressant drug Prozac. The determination of fluoxetine and its metabolite norfluoxetine. Figure 12.31 b, in serum is an important part of monitoring its therapeutic use. The analysis is complicated by the complex matrix of serum samples. A solid-phase extraction followed by an HPLC analysis using a fluorescence detector provides the necessary selectivity and detection limits. 

See L. Slater, Kafka s Boys A Story of Sex and Serotonin, in C. Elliott and T. Chambers, eds., Prozac as a Way of Life (Chapel Hill, N.C. University of North Carolina Press, 2004) H. Shaffer, M. Hall, and J. Vander Bilt, Computer Addiction A Critical Consideration, American Journal of Orthopsychiatry 70 (April 2000) 162-168. For an analysis of how children are inducted into America s consumer culture, see J. Schorr, Bom to Buy The Commercialized Child and the New Consumer Culture (New York Scribner s, 2004). 

St. John s wort, like all plants, produces an array of compounds, which can account for its antianxiety and antidepressant effects. These effects are more than anecdotal they are supported by a number of studies. Most of these studies have been carried out in Germany, where doctors frequently prescribe standardized versions of the plant as an antidepressant. They actually write more prescriptions for Johanniskraut, as the plant is known in that neck of the woods, than for Prozac. In hght of a meta-analysis — a study of studies — published in 1996 in the British medical journal The Lancet, the choice of those German doctors seems justified. 

A meta-analysis study by Whittington et al. (2004) in The Lancet found that the combination of published and unpublished studies led to the conclusion that with the possible exception of Prozac, there was no indication of efficacy for the antidepressant treatment of children. In addition, not noted in the article is the fact that the two key studies in favor of Prozac were supported by Eli Lilly, one directly and the other indirectly through funds funneled through NIMH,1 and that the lead author in both was Graham Emslie (Emslie et al., 2002, 1997). Emslie was task force cochair and second author of the ACNP s infamous defense of antidepressants. Emslie s industry affiliations included Grants/Research Support Eli Lilly, Novartis,... 

Jick et al. (1995) stretched beyond reason to take their position that Prozac might not be the cause of the suicides.1 They found that when the analysis was restricted to those without a history of having felt suicidal or who had taken only one antidepressant, the increased risk for those who took fluoxetine was reduced. Thus, the increased risk was reduced by these manipulations but not eliminated. Data in a table show that after taking into account a past history of suicidal behavior and/or antidepressant use, Prozac remained twice as likely to be associated with suicide as any other antidepressant. In fact, Prozac became the only antidepressant that was associated with increased, risk of suicide. 

According to the FDA-approved label for fluvoxamine (Luvox in the Physicians Desk Reference, 2001), the SSRI causes a 4% rate of mania in children under age 18, compared to no cases of mania produced in a similar group of children on placebo. The rate was at least 4 times greater than in adults (see Breggin, 2002a, for a more complete analysis of the Luvox label). Moore (2004) analyzed adverse event reports made to the FDA concerning children and adults in association with the six most commonly prescribed antidepressants Zoloft, Paxil, Prozac, Cel-exa, Wellbutrin, and Effexor. Fie reported the following ... 

In 2006, British psychiatrist Joanna Moncrieff and Kirsch published another review and analysis of antidepressant effectiveness in the BMJ. They focused on studies conducted on SSRIs such as Prozac, Zoloft, and Paxil and concluded that these drugs do not have a clinically meaningful advantage over placebo. ... 

As far as I can ascertain, these extremely important facts and analyses about Prozac-induced suicidality were never submitted to the FDA or in any way made available to the government, the profession, or the public. To the contrary, Eli Lilly has maintained—and continues to maintain— that there is no evidence whatsoever for increased suicidality on Prozac. As an example, Eli Lilly did not make known its analysis of increased suicidality on Prozac at the 1991 FDA conference (FDA, 1991). Nor did they present the Beasley data on increased activation (Beasley, 1988 as for all documents in this section, available on www.breggin.com). 

Kirsch, L, Sapirstein, G. (1999). Listening to Prozac but hearing placebo A meta-analysis of antidepressant medications. In I. Kirsch (Ed.), How expectancies shape experience (pp. 303-320). Washington, DC American Psychological Association. 

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