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.