"The Indianapolis Star", 4/06/2000 ==================== Book slams Prozac as overused, dangerous Lilly launches counterattack, says 'fear-mongering' publication may harm vulnerable patients.

By Jeff Swiatek The Indianapolis Star Last updated 01:47 AM, EST, Thursday, April 06, 2000 Rarely free of controversy for long, Prozac comes under attack again in a new book that has raised the ire of Eli Lilly and Co.

Prozac Backlash, which hit bookstores Wednesday, calls Prozac and its antidepressant cousins overused, over-hyped and overly dangerous.

"We already know enough to indicate these drugs should be prescribed far more cautiously," writes author Dr. Joseph Glenmullen, a practicing psychiatrist in Cambridge, Mass.

The 383-page book goes where past mainstream criticisms of Prozac seldom have gone before, saying Prozac and similar drugs might be toxic to the brains of patients.

An unusually strongly worded response was issued Wednesday by Lilly, the inventor and maker of the familiar green-and-white capsule that came on the market in the late 1980s and has become one of the best-selling drugs in the world.

"Dr. Glenmullen's book is a collection of half-truths, omissions, errors and personal anecdotes," Lilly said.

The Indianapolis drug maker said its officials worry that "the book is a fear-mongering publication that may prompt those with depression to abandon their medication and seek medically unproven alternatives."

In that regard, the book is "dangerous," added Lilly spokesman Jeffrey G. Newton.

Danger is what Glenmullen sees ahead for many patients who turn to Prozac and its handful of chemical rivals, such as Zoloft and Paxil, to cure problems that he says don't warrant mind-altering medications.

Glenmullen filled his book with case studies of patients he has treated who have suffered from what he sees as antidepressant "backlash." Those include sexual dysfunction, memory loss, grotesque facial tics, anxiety and even suicidal tendencies.

He also tells of patients swallowing ever-higher doses of Prozac and similar drugs to overcome what some doctors call "Prozac poop-out," or the body's tendency to outsmart the medication.

Glenmullen warns that the Prozac class of drugs could go the way of cocaine, some tranquilizers and other once-promising "mood brighteners" that were found after years of widespread use to be toxic to the brain.

"Common sense suggests that if all the once-popular prescription drugs -- including cocaine, amphetamines and discredited diet pills -- are neurotoxic, then the related, currently popular medications like the Prozac group may be too," the book says.

Such allegations provoked sharp responses from Dr. Steven M. Paul, one of Lilly's top scientists, who is being made available for news media interviews to combat charges in Glenmullen's book.

"We've never found anything like that," Paul said of the notion that Prozac might be toxic to the brain. "It couldn't be further from the truth."

Paul referred to parts of the book as "ludicrous" and "unbelievable"

and the book itself as "a diatribe."

He rejected charges in the book's opening chapter that Prozac can cause disfiguring facial tics, including "flycatcher tongue."

Prozac can cause muscle twitches in some patients, but to say it causes the severe tics described by Glenmullen "is unconscionable,"

said Paul, who is group vice president of Lilly Research Laboratories and a former scientific director at the National Institute of Mental Health.

Lilly is used to defending Prozac from critics.

During the early 1990s, the main detractor was the Church of Scientology. A Maryland psychiatrist, Dr. Peter R. Breggin, wrote two books critical of Prozac in 1994 and 1999.

Prozac Backlash is a densely footnoted work, with 35 pages of footnotes. That means the debate over the book's charges could come down to a question of whose scientific studies to believe.

Glenmullen, for instance, cites studies showing the Prozac class of antidepressants cause sexual dysfunction in up to 60 percent of users.

Paul contends Prozac causes "20 to 30 percent, max" of mild to moderate sexual dysfunction.

"For every footnote he cited (showing high rate of sexual dysfunction) I can show you other citations with larger numbers of patients that say just the opposite," Paul said.

The book worries officials at the National Mental Health Association, said Laura Young, vice president of community services.

"My fear with books like this is it scares people away from getting the really important treatment they need ... and they may mess around with herbal alternatives."

Glenmullen, a graduate of Harvard Medical School, said in his book that he believes Prozac and similar drugs do help some people with depression and that he still prescribes the drugs himself in his practice.

The book's New York publisher, Simon & Schuster, is sending Glenmullen on a seven-city tour to promote the $25 book, starting Monday.

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