April 13, 2000
MedscapeWire -------- The National Mental Health Association (NMHA) has voiced concern over what it called misleading statements in a new book that claims antidepressant medication is over-prescribed and causes serious side effects. The NMHA also expressed concern that the book, _Prozac Backlash_, could discourage people from seeking treatment.

NMHA's criticism of the book, written by Boston psychiatrist Joseph Glenmullen, MD, was echoed by 2 leading psychiatrists, who said that the book's messages were misleading and irresponsible.

"The truth about depression and its treatment is just the opposite of what the book claims," noted Mike Faenza, president and chief executive officer of NMHA. "In fact, clinical depression remains underdiagnosed and undertreated. And the new generation of medication for depression is much safer and more effective than those of the past."

Faenza noted that depression is a very serious health problem for more than 19 million Americans, and left untreated can result in years of suffering and even suicide. Only about half of those with the illness seek and receive appropriate treatment, which includes psychotherapy, medication, or a combination of the two.

Faenza cautioned that the book could have serious consequences if people accept its contents as fact. "Our organization has worked hard over the past decade to raise awareness about depression and the need to get help. We're concerned that people may decide against seeking appropriate treatment for this serious illness after hearing about this book."

A number of leading psychiatric researchers, whose work is cited by the book's author have also been critical of _Prozac Backlash_. "In cases where Dr. Glenmullen quoted studies published by me, he quotes the work out of context to fit his needs," said Anthony Rothschild, MD, professor of psychiatry at the University of Massachusetts Medical School. "This book is misleading, and does a great disservice to people with depression. The very medications that the author claims are overused are, in fact, well studied, closely scrutinized, and closely regulated."

"Dr. Glenmullen goes well beyond the published research on the side effects of these newer antidepressant medications, the SSRIs [selective serotonin reuptake inhibitors], and into pure speculation," warned Harvey Ruben, MD, MPH, clinical professor at the Department of Psychiatry at Yale School of Medicine.

"His messages are an irresponsible deterrent to those seeking help for depression, and border on inflammatory journalism."

The psychiatrists noted that SSRIs and other new medications for depression do have adverse effects that effect some patients. "This is true for any medication that treats any illness, and patients should always discuss side effects with their doctor," noted Dr. Ruben. "However, it is the overall safety and low incidence of serious side effects with these newer medications that have made them so effective in the treatment of depression."

Both psychiatrists noted that the suffering from depression usually far outweighs the adverse effects, usually temporary and minimal, of antidepressant medication. They shared the concern of the NMHA that the book's messages could cause people to avoid seeking help for depression, cause those now receiving treatment to discontinue it, or persuade people to use unproven, unregulated treatments including herbal remedies such as St. John's Wort.

"The sad fact is that stigma still surrounds treatment for mental illness," warned Faenza. "And books like this one unfortunately only add to this stigma. The real message about mental illness is one of hope --- that most people can recover with appropriate treatment."

In fact, Faenza noted, the US Surgeon General recently released the first-ever Report on Mental Health, which identified mental health and mental illness as a key public health issue, and underscored the effectiveness of mental health treatments and services.

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