Ask Larry:

Question: My niece is 15 years old. She has been showing signs of mild-moderate depression. My sister took her to a psychiatrist who after one visit prescribed Prozac. Aren’t these drugs dangerous for kids? Shouldn’t they try diet, exercise and counseling first?

Larry’s Response: I am behind you 100% on your evaluation and concerns.

First, it is unlikely that a 15 year old person would have depression to an extent that they would automatically need a prescription drug – without even considering other approaches.

Second, Prozac might not be addicting in the common sense, but people can become dependent on it. They learn to want the feeling they get when they take it.

Third, until a doctor knows what might be triggering the depression episodes, he/she is doing a disservice by jumping to a conclusion about the need for a drug.
One important thing to know about Prozac is that its primary indication is for people with Major Depressive Disorder. While it is surely possible that a 15 year old girl can suffer from such a condition, it seems highly unlikely that a concerned doctor would make that diagnosis and begin drug treatment on the first visit. This makes me very uncomfortable and I would surely question that doctor’s abilities.

Children of that age can easily experience hormone imbalance. Also, they consume far too much sugar and artificial sweeteners – both of which can wreak havoc on blood sugar and insulin levels. Rapidly changing blood sugar and insulin is often associated with mood swings. There’s the high associated with the consumption, followed by a low that can last until the next dose of sugar.

There are other substances in food that can mess with emotional balance. They can be referred to as excitogens, substances that trick the brain into tasting things that just aren’t there. One example is monosodium glutamate (MSG). It has long been added to prepared foods to make them taste better (old chicken meat tastes better in soup when there is MSG present). In some people these chemicals are linked to migraines. It is not a surprise that they can be linked to mood.

Without knowing other personal details about your niece, I sure couldn’t offer specific suggestions. However, I can state that any approach is superior to drugs. One of particular importance is the use of fish oil. There are even scientific studies that demonstrate the superiority of DHA and EPA in improving brain chemistry.

Here’s one final statement that might not sit well, but I think it needs to be stated. When a person goes to a butcher shop, she can expect that the butcher will want to sell meat. That’s what butchers do.

It is not unexpected to get a prescription for a drug when visiting a psychiatrist. That’s what psychiatrists do.

It is far more difficult to address underlying issues and resolve them. Drugs are quick and easy – rarely the best option, but the most common.

All medicines may cause side effects, but many people have no, or minor, side effects. Still, take a look at the kinds of things that have been reported by people who have used this drug. They would not be on this list if they had not been experienced by Prozac users. Yes, the percentage of reported side effects is often small, but it ends up being 100% if you’re the unlucky one to have the bad experiences.

Check with your doctor if any of these side effects persist or become bothersome:
Abnormal dreams; anxiety; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; flu-like symptoms (eg, fever, chills, muscle aches); flushing; increased sweating; loss of appetite; nausea; nervousness; runny nose; sore throat; stomach upset; trouble sleeping; weakness; yawning.
Seek medical attention right away if any of these side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); bizarre behavior; black or bloody stools; chest pain; confusion; decreased concentration; decreased coordination; exaggerated reflexes; excessive sweating; fainting; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; increased hunger, thirst, or urination; joint or wrist aches or pain; memory loss; new or worsening agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still; persistent or severe ringing in the ears;persistent, painful erection; red, swollen, blistered, or peeling skin; seizures; severe or persistent anxiety, trouble sleeping, or weakness; severe or persistent nausea, vomiting, diarrhea, or headache; significant weight loss; stomach pain; suicidal thoughts or attempts; tremor; unusual bruising or bleeding; unusual or severe mental or mood changes; unusual swelling; unusual weakness; vision changes; worsening of depression.

There’s another interesting observation about Prozac. It is available commercially as a 10mg or 20mg capsule. There have been numerous reports, however, that a very effective dose is 5mg. In fact, one study demonstrated that 5mg was practically as effective as the 10mg dose in treating major depression. Why do you suppose the effective dose isn’t even available commercially? I have suspicions but insufficient information to state them.

Regardless, this dosing fact suggests that practically everyone who is prescribed Prozac is taking too much. It seems that someone is taking the easy way out. Instead of working to find the correct dose that’s really needed for major depression, the doctors are allowed to prescribe doses that are two to four times the proven effective dose. This is unacceptable and does not indicate that the drug makers or doctors actually care about our health.

Convenience and profitability trump all clinical aspects of this drug.

Too many people take too many drugs. The drug makers are selling their wares and the land is full of people with doctor degrees who could care less about the health of a patient. My list of excessive, unnecessary drugs includes statins for cholesterol, PPI drugs to reduce stomach acid, and hormones (especially estrogen). I must add psychoactive drugs to that list as well. It seems there aren’t many kinds of drugs I would approve of.

That’s the point. I remain The UnDruggist.