Peter D. Kramer, M.D. tells of his first experience with Prozac involving a woman named Tess. Tess was the eldest of 10 children, born to a passive mother and an alcoholic father. Tess was physically and sexually abused as a child. When Tess was 12 her father dies and her mother entered a clinical depression from which she never recovered. Tess was then left to take over the family.
Later in life Tess made a business career out of her skills at driving, inspiring, and nurturing others. She was very unhappy in her personal life. Tess struggled from one abusive married man to another. Despite psychotherapy, she was progressively less energetic and more unhappy.
Dr. Kramer’s first visit with Tess showed she had all the symptoms of clinical depression and she wanted to end her life. Dr. Kramer prescribed Prozac for Tess to terminate her depression and return her to her “premorbid self.” Dr. Kramer’s goal was to not transform Tess but to restore her.
Two weeks after using Prozac, Tess reported she was no longer feeling weary. She confessed she had been depleted of energy for as long as she could remember and realized she had been depressed all her life. Tess once again was able to get her social life back.
Dr. Kramer took Tess off Prozac after nine months and she continued to do well. Tess did admit she didn’t seem as sharp or energetic after discontinuing the medicine. Then, after about eight months off Prozac, Tess felt she was slipping. She liked the feeling of stability that Prozac gave her. Dr. Kramer was then left to decide whether or not to prescribe Prozac to a patient who was not depressed. Again on Prozac, Tess responded as she had hoped, self-assurance, renewed confidence, and social comfort.
Not all patients on Prozac respond this way. Some are unaffected, some merely recover from depression as they might on any medication. But a few are transformed.