Prozac

An antidepressant that changed psychiatry.

Fluoxetine, trade-name Prozac, was the first selective serotonin reuptake inhibitor (SSRI)¹. Welcome to the Frontier Psychiatrists newsletter. It is a health-themed publication written by a child and adult psychiatrist. I'm doing a series of essays on individual medications, as I have decided not to use them as the mainstay of my psychiatric practice anymore.

Meds? Less of those, perhaps. © Angela Cappetta, LLC 2023

I’m focusing on neuromodulation as a first-line treatment. I think it's a better first-line treatment. I didn't learn how to use medication by not thinking about them, prescribing them, or reading primary literature voraciously. Thus, I have spare thoughts to share! I am a thinking process enthusiast—over thought content, any day.

Dr. Faust: I was tempted by the devil, and I know no temptation is tempting unless the devil tells you so….

What the hell did you want my soul for? How do you know I have a soul?…everybody knows the devil is all lies.

—Gertrude Stein, Dr. Faustus Lights the Lights

It's been a while since Prozac was introduced in 1987. It is easy to forget why it was an exciting medication for Psychiatry. Prozac will not kill you if you take too much of it most of the time. It is not particularly toxic in overdose. The same cannot be said of prior psychiatric medications for depression. Former stars of the pharmacopeia included tricyclic antidepressants (imipramine, desipramine, nortriptyline, etc.).

Prozac is the most popular antidepressant on earth:

Since [1988], fluoxetine has become the most widely prescribed antidepressant drug in the world.

The toxic nature of prior antidepressants is a horrible stroll down bad memory lane, but it is necessary to understand why Prozac was such a big deal.