Parnate) or tricyclic antidepressants (TCAs, such
as Elavil). MAOIs and TCAs increase levels of
norepinephrine and serotonin; low levels of these
neurotransmitters are thought to play a crucial role
in causing depression. However, the severity and fre-
quency of MAOI and TCA side effects, particularly
the MAOIs, prompted researchers to search for ef-
fective compounds with a less deleterious side effect
profile. The culmination of this research helped to
launch an antidepressant revolution in the 1990’s.
Trends in the 1990’s In 1987, Prozac (fluoxetine
hydrochloride) was the first of a new category of an-
tidepressants, selective serotonin reuptake inhibi-
tors (SSRIs), to be approved by the FDA. Prozac
proved to be just as effective as the older antidepres-
sants, but with less severe side effects. The success of
Prozac in the early 1990’s prompted other pharma-
ceutical companies to produce different SSRIs
(such as Celexa, Lexapro, Luvox, Paxil, and Zoloft)
and reuptake inhibitors that targeted serotonin
and norepinephrine (SNRIs, such as Effexor) or
norepinephrine and dopamine (NDRIs, such as
Wellbutrin SR). In addition to a better side effect
profile, the newer antidepressants were sufficiently
different in molecular structure—the TCAs are
chemically similar—and offered physicians numer-
ous treatment options: Patients who did not respond
positively to one reuptake inhibitor often had suc-
cess with another, unlike with the TCAs. More and
better drug options, intense marketing by pharma-
ceutical companies, and books such as Peter
Kramer’sListening to Prozac(1993), extolling the vir-
tues of antidepressants, combined to lead to a dra-
matic upsurge in the use of antidepressants in the
1990’s.
InPsychopharmacology for Helping Professionals: An
Integral Exploration(2006), R. Elliott Ingersoll and
Carl Rak identify three trends in the use of antide-
pressants in the 1990’s: steep increases in prescrip-
tions, greatly expanded usage in elderly and pediat-
ric populations, and burgeoning off-label use (the
drug is used for a purpose other than what it was ap-
proved for), such as for personality disorders or
chronic pain syndromes. The authors also note that
as the number of people receiving antidepressants
increased in the 1990’s, the number of individuals
undergoing counseling for depression decreased.
Issues in the Use of Antidepressants Psychiatrist
David Healy asserted inThe Antidepressant Era(1997)
that the financial interests of pharmaceutical com-
panies obfuscated an objective evaluation of the effi-
cacy and safety of antidepressants. A growing body of
research has brought into question the effectiveness
and safety of antidepressants, giving credence to
Healy’s concerns.
Since the late 1990’s, a number of well-designed
studies examining the effectiveness of antidepres-
sants in treating depression have found little differ-
ence between the drugs and placebos. Moreover, a
significant percentage of adults taking SSRIs will ex-
perience sexual dysfunction, multiple adverse side
effects, and/or develop dependence on the drugs.
Thus, the emerging picture since the 1990’s is that
the effectiveness of antidepressants has been exag-
gerated and their side effects have been significantly
downplayed. These findings have particular rele-
vance for younger populations because most antide-
pressants have not been approved by the FDA for use
by children, and the side effects are more severe and
have longer-lasting consequences. For example,
mouse pups given Prozac develop excessive fear and
restlessness in adulthood. Furthermore, some stud-
ies begun in the 1990’s reported a positive correla-
tion between increased suicidality risk and antide-
pressant use. Subsequent research prompted the
FDA in 2004 to issue a “black box” warning label on
all antidepressants, apprising consumers that anti-
depressants may increase the risk of suicidal thoughts
and behavior in children and adolescents. In 2007,
the FDA expanded the warning to include people
up to the age of twenty-five.
Impact By 2007, SSRIs had become the best-selling
drug of any kind in the United States; nearly one in
eight Americans had tried an SSRI. The trend begun
in the 1990’s of more people using antidepressants
than employing counseling in treating depression
continued well into the subsequent decade. It ap-
pears that the 1990’s ushered in a cultural percep-
tion that psychological problems are best solved by
pills, not people.
Further Reading
Glenmullen, Joseph.Prozac Backlash: Overcoming the
Dangers of Prozac, Zoloft, Paxil, and Other Antidepres-
sants with Safe, Effective Alternatives. New York: Si-
mon & Schuster, 2000. A Harvard psychiatric
professor examines the risks associated with anti-
depressants (especially SSRIs), reviews the anti-
depressant research, and discusses alternative42 Antidepressants The Nineties in America