4 ■
FALL 1994 ISSUE ■ SINAI HOSPITAL
HealthNews
Prozac: Use or Abuse?
0
n Dec. 16, 1993,
a teacher in
Chelsea, Mich.,
shot and killed
his superior following a
reprimand. During the
ensuing trial, the defense
argued that the teacher's
use of the prescription
drug Prozac caused him
to pull the trigger. Prozac,
the most commonly pre-
scribed anti-depressant
in the world, has been
at the heart of a contro-
versy over the wide-
spread belief that
the drug has se- (4i)
vere side effects,
including an increase
in the tendency to-
ward violent behavior.
The degree of alarm
is excessive, according
to Sinai Hospital's Di-
rector of Psychiatry
Residency Education El-
liot Luby, M.D. "Prozac is
a very safe drug and is ef-
fective in the treatment
of 70 to 80 percent of pa-
tients. It is primarily used
to treat depression and
obsessive compulsive dis-
orders and does not, in
itself, cause violent or sui-
tidal behavior."
Introduced in 1988,
Prozac is prescribed to
nearly one million people
each month. Prozac
works by increasing sero-
tonin levels in the areas
of the brain that control
human emotions. Sero-
tonin is a neurotransmit-
ter that regulates a
person's moods. Prozac
can start working
within three
weeks to allevi-
© ate depression.
Its most
common
side effect is
akathisia, or intense rest-
lessness.
According to Dr. Luby,
the concern over Prozac
stems from the myth that
the drug is "transforma-
tional" or that it changes
an individual's personal-
ity. "It simply does not
alter someone's personal-
ity," Dr. Luby empha-
sizes. "However, there are
some appropriate con-
cerns about over-pre-
scription." Unfortunately,
a growing number of
Prozac users are not clin-
ically depressed but are
personally dissatisfied
and use Prozac to over-
come distress rather than
address the underlying
causes of their difficulties.
"Prozac is not a mira-
cle drug that changes peo-
ple," says Dr. Luby. "It
won't cure the struggles
of daily living, but Prozac
is successful in treating
clinical depression."
In the case of the
Chelsea teacher accused
of murder, the defense ar-
gued that Prozac had
caused a substance-in-
duced mood disorder that
led to the murder. Dr.
Luby testified for the
prosecution in the case,
saying that Prozac was
not responsible for the
man's violent act. The
teacher was recently
found guilty of first de-
gree murder.
Sinai Offers New Hope for MS Patients
S PEC IAL ADVE RT IS E ME NT
M
ultiple sclerosis (MS)
is the most common
acquired nervous sys-
tem disease in young
adults. Although its causes are not
fully understood, MS most often
afflicts women in their late 20s and
early 30s and can result in loss of
balance, walking problems, weak-
ness or partial paralysis, visual
loss, speech difficulties and incon-
tinence. MS has no cure.
Only recently, has MS been
identified as an autoimmune dis-
order. In MS cases, the immune
system treats the lining of the
body's nerves as foreign objects
and works to destroy the lining.
Pinpointing the source of the dis-
ease could effect a tremendous
difference in treatment.
Sinai Neurologist Danny F. Watson, M.D., tests the reflexes
"In just the last few years, of a patient.
we've learned a great deal about
this disease," says Sinai Hospital's Divi- offers many advantages to MS patients be-
sion Chief of Neurology William Leuchter, cause we have experts who deal with the
M.D. "Because we now know MS is relat- different facets of the disease," he says.
ed to the immune system, we can offer Neurologists lead a team of MS health pro-
fessionals that includes neuro-radiologists,
several forms of treatment."
Treatment can address the symptoms who test advancement of the disease, and
of MS as well as the correction of the dis- physical medicine and rehabilitation spe-
abled immune system. "We can use vari- cialists, who help patients remain mobile
ous drugs, such as steroids, to treat the and functional despite symptoms.
"It's important to note that tremendous
muscle weakness and help patients feel
stronger in their movements," Dr. Leuchter advancements have been made in the
says. To treat the damaged immune sys- treatment of MS," says Dr. Leuchter. "It is
tem, low-dose chemotherapy has brought far more treatable today than it was five
years ago, and the work of a highly skilled
guardedly optimistic results.
According to Dr. Leuchter, Sinai offers medical team can make all the difference
MS patients a wide range of care. "Sinai to a patient."
•.-
WINKV:sft:
, v4v,
As a satellite center of The University of Michigan's Alzheimer's disease research program, which
Peter LeWitt, M.D., directs, Sinai has access to the latest treatments and research available for
Alzheimer's patients.
Research Holds the Answers
to Alzheimer's Disease
0
ne in seven adults over age 70
will develop Alzheimer's dis-
ease, a disorder that leads to
progressive deterioration of the
brain's nerve cells. Alzheimer's disease
is responsible for the majority of cases of
dementia, often regarded as senility, in
the aging population. Worsening
of memory, confusion, loss of orientation
and difficulty in everyday functioning
are typical symptoms of Alzheimer's dis-
ease. Families of affected persons often
feel helpless watching loved ones become
increasingly impaired. Given the chal-
lenges of this late-life disorder, Sinai Hos-
pital neurological researchers are
working to learn more about the causes,
treatment and possible preventive strate-
gies for Alzheimer's disease.
Although there is no cure for Alz-
heimer's disease, several medication tri-
als are currently underway at Sinai's
Clinical Neuroscience Center in West
Bloomfield. "We are involved in several
clinical trials of drugs to measure their
effectiveness in improving memory, alert-
ness and other aspects of the mind's
impairment," says Neurologist and
Director of Sinai's Clinical Neuroscience
Center and Movement Disorders Clinic
Peter LeWitt, M.D.
Together with Dr. LeWitt, Neurolo-
gist Richard M. Trosch, M.D., and other
Sinai clinicians provide detailed evalu-
ations, diagnostic studies, and coordi-
nate support services for patients and
their families. The clinical trials are of-
fered at no charge and give patients ac-
cess to medications that may remedy
some of the problems found with this dis-
order.
In addition to these clinical services,
Sinai's Clinical Neuroscience Program
is also involved in laboratory research
into the causes of Alzheimer's disease.
Researcher David Loeffler, D.V.M.,
Ph.D., has carried out several studies
characterizing the abnormal features of
the Alzheimer's disease-affected brain.
'We found a particular protein, cerulo-
plasmin, whose presence is increased at
only the sites in which the disease is
prominent," explains Dr. Loeffler. These
finds may lead to early warnings of the
disease and an increased understanding
of its causes.
As a satellite center of The Universi-
ty of Michigan's Alzheimer's disease re-
search program, which Dr. LeWitt
directs, Sinai has access to the latest
treatments and research available for
Alzheimer's patients.
Between its clinical services and re-
search activities underway at Sinai, the
Clinical Neuroscience Center hopes to
someday unlock the mysteries of this dis-
order and provide new hope to patients
and their families.