DOES PROZAC TRANSFORM PERSONALITY?

Personality transformation as a result of taking Prozac is a concept articulated most strongly by the psychiatrist Peter D. Kramer, M.D., author of the best-selling book, Listening to Prozac. “Prozac seems to give confidence to the habitually timid, to make the sensitive brash, to lend the introvert the social skills of a salesman,” he wrote. He pointed out that “Not all patients on Prozac respond this way. Some are unaffected by the medicine; some merely recover from depression, as they might on any antidepressant. But a few, a substantial minority, are transformed.”

There’s no question that psychotropic drugs of all kinds, including anti-anxiety drugs, mood stabilizers, tranquilizers, and antidepressants, have the power to transform. When you change an individual’s mood, lifting a person out of a depression (or calming down someone who is experiencing a manic high), that person’s emotions, behavior, and even motor activity alter right along with (he mood. A person who is less depressed becomes by definition livelier, more hopeful, and more energetic. It might sound like a transformation, but most patients don’t experience it that way. This is an important change, no question about it. But to label it a transformation is, in my view, to romanticize it and ignores the widely known genetic studies in this field. The reality is that all depressives, once they have returned to their normal state of mind, will say that they feel better about themselves and are more outgoing, efficient, and assertive. All antidepressant drugs can achieve those results. This is not news. Similarly, when depressed people with the propensity toward manic and hypomanic periods take antidepressant drugs, they tend to feel a greater sense of well-being than those without that propensity. And, because they are often dramatic, rejection-sensitive, histrionic personalities who magnify the elements of their lives, they make persuasive claims. They don’t just feel better, they will tell you that with Prozac, they feel better than they’ve ever felt in their lives.

This is not news either, although the media has made it seem so. As a group, these patients are hyperresponders who respond to all antidepressants and stimulants. And sooner or later, with every antidepressant that we’ve had, some of them slip into manic psychosis and end up in the hospital.

A few cases nonetheless appear to offer a stronger case for transformation, partially because these patients will waltz into the office on the very next visit and announce that they have been transformed. And indeed, the change is often dramatic. These patients are not merely lifted out of depression; they are elated. In the overwhelming number of cases, the reason for this so-called transformation is that these patients—often rapid responders—have always had a dual nature; they are sometimes depressed—sometimes for years on end—and they are sometimes, perhaps not as frequently, revved up. They are, in short, subtly bipolar. These are not full-blown manic-depressives; but they do have a family history of or a mild tendency toward the elevated moods of hyperthymia, hypomania, or cyclothymia. Prozac—or any other antidepressant, often enough—will nudge them into the manic zone—a place they have been before. Once there, they feel very, very good. And they will tell you so in vivid, dramatic language. But is this a

transformation? If you think of the patient as a depressive, it may appear to be. If you think of the patient as a soft bipolar, it is not.

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