But these side effects were vastly milder than the cardiac problems, lethal overdoses and urination difficulties that people on previous antidepressants suffered. Now, people seeking a chemical lifeline for life's storms are faced with a dizzying array of choices, each promising its own customized version of a safe harbor.
Side effects can be the deciding factor in choosing an antidepressant.
If Prozac doesn't work for a patient, or a patient cannot tolerate its side effects, Kramer said, the psychiatrist now has more choices and can prescribe a slightly different drug. Prozac alternatives now include Zoloft, Paxil, Effexor, Serzone, Luvox, Remeron and, most recently, Celexa, which was approved by the FDA in July 1998. The chemical structure of each SSRI is slightly different from the others, which means each drug affects patients in a slightly different way. Paxil, for example, seems to be more sedating than Prozac, and is also prescribed for anxiety and panic attacks. But a quick browse through the hundreds of Web sites, forums and chat rooms devoted to Prozac and other antidepressants is all that's necessary to see that these drugs don't always act as the clinical trials predict they will.