Critique of the DSM and Biomedical Perspective

Although Prozac lifted Lauren’s depressive and obsessive-compulsive symptoms, antidepressants generally are not as effective for everyone. Indeed, they may work better for anxiety than depression. About 68% of the improvement in depressive symptoms is from the placebo effect; additionally, only a third of people remit from depression with their first course of antidepressants, and half experience a 50% reduction in symptoms. In sum, although people respond to antidepressants, the effect of medication for depression is not spectacular. A recent meta-analysis showed that only for severe depression were antidepressants worth the risk-benefit ratio.

Finally, side effects are underreported to doctors. The main side effect with which Lauren struggled was lack of sexual desire/difficulty having orgasm, a common reaction to antidepressants. This seemed to become more of a problem when Lauren entered into a monogamous relationship; she and her then boyfriend tried all sorts of alternative remedies to try to correct the side effect, but nothing appeared to help with this issue.

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Acknowledgement: Warm thanks to Diane Hazzard, my student of summer 2008, for the majority of this analysis of PROZAC DIARY.

Treatment Plan

Treatment Plan

Biological
Lauren’s treatment plan is mainly biological and the book is about her experience of taking Prozac. From her account, it seems that she has regular contact with her prescribing psychiatrist.

Psychological
Based on Lauren’s past suicide attempt(s) and suicidal ideation, the practitioner must assess her current risk for suicide and continue to monitor this throughout treatment. The practitioner can make sure to assess risk using a strengths-based approach by inquiring how Lauren has dealt with and got over her thoughts of self-harm in the past.

Although we know that Lauren has been hospitalized, it isn’t clear the treatments she received. Her “anxiety about eating” remains a concern (she claims that she had anorexia nervosa when she was younger). Further assessment of her eating patterns and extent of body disturbance is warranted.

Clearly, the writing of her memoir was a way that Lauren worked through her depression and her recovery. The fact that it was published and reached such a wide audience likely helped her experience meaning from the depression.

Social
As part of her recovery from depression, which Lauren attributes to Prozac, she says that she was able to have friends when she returned to graduate school and she eventually met a romantic partner. However, at the outset of the book, it seems that a referral to a cognitive-behavioral group might have helped her cope better, teach her needed social skills, and address some possible cognitive distortions that may get in the way of her recovery (“I’ll lose my creativity if I’m depressed). One of her major risk factors for a compromised adjustment is her isolation and lack of social support and group treatment may provide her with some beginning support and skills that she can take into other relationships.

The Frame or Structure of PROZAC DIARY

PROZAC DIARY opens with Lauren seeking help from a psychiatrist who specializes in the then new antidepressant, Prozac, for the recent emergence of Lauren’s obsessive/compulsive symptoms. PROZAC DIARY spans over several years of her life in which time Lauren completes a Masters degree in psychology and becomes involved in a long-term romantic relationship. As the title implies, PROZAC DIARY is organized around Lauren’s experience with Prozac. She was one of the first people in the United States to be on Prozac and was part of a clinical trial (although she does not describe the experience of being part of the research). Clinical notes from her treatment are provided intermittently throughout the book at the start of some chapters.

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