Eternal sunshine

It's sold as happiness in a blister pack - a cure-all that has changed the way we think about wellbeing. As Prozac reaches its 20th birthday, Anna Moore presents 20 things you need to know about the most widely used antidepressant in the world

Sunday May 13, 2007

Observer Article

1: Depression has deepened

In 1971, when LY110141 - the compound that became Prozac - was developed, depression was rarely discussed and antidepressants largely restricted to the psychiatric unit. People went to their GPs with 'anxiety' and 'nerves'. Tranquillisers such as Valium were a likely response.

Eli Lilly, the company behind Prozac, originally saw an entirely different future for its new drug. It was first tested as a treatment for high blood pressure, which worked in some animals but not in humans. Plan B was as an anti-obesity agent, but this didn't hold up either. When tested on psychotic patients and those hospitalised with depression, LY110141 - by now named Fluoxetine - had no obvious benefit, with a number of patients getting worse. Finally, Eli Lilly tested it on mild depressives. Five recruits tried it; all five cheered up. By 1999, it was providing Eli Lilly with more than 25 per cent of its $10bn revenue.

Fluoxetine was handed to Interbrand, the world's leading branding company (Sony, Microsoft, Nikon, Nintendo) for an identity. The name Prozac was picked for its zap: it sounded positive, professional, quick, proey, zaccy. It was marketed in an easy-to-prescribe 'one pill, one dose for all' formula and came when the medical profession and media were awash with horror stories about Valium addiction.

Prozac hit a society that was in the mood for it. National campaigns (supported by Eli Lilly) alerted GPs and the public to the dangers of depression. Eli Lilly funded 8m brochures (Depression: What you need to know) and 200,000 posters. Previous antidepressants were highly toxic, lethal if overdosed on and had other nasty side-effects. Prozac was pushed as entirely safe, to be doled out by anyone. It was the wonder drug, the easy answer, an instant up, neurological eldorado. When launch day dawned, patients were already asking for it by name.

Twenty years on, Prozac remains the most widely used antidepressant in history, prescribed to 54m people worldwide, and many feel they owe their lives to it. It is prescribed for depression, obsessive compulsive disorder, panic disorder, eating disorders and premenstrual dysphoric disorder (formerly known as PMT). In the UK, between 1991 and 2001, antidepressant prescriptions rose from 9m to 24m a year.

Strangely, depression has reached epidemic levels. Money and success is no defence: writers, royalty, rock stars, supermodels, actors, middle managers have all had it. Studies suggest that in America, depression more than doubled between 1991 and 2001. In the UK, an estimated one in six people will experience it - and it costs more than £9bn annually in treatment, benefits and lost revenue. Meanwhile, according to the World Health Organisation, depression is set to become second only to heart disease as the world's leading disability by 2020.

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