Use of Anti-depressants



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Running head: USE OF ANTI-DEPRESSANTS FOR INDIVIDUALS WITHOUT A DSM-IV DIAGNOSIS

Use of Anti-Depressants for Individuals without a DSM-IV Diagnosis

Zara Mogilevsky

Barnard College of Columbia University

Abstract

The current study aimed to examine the effects of Prozac (Fluoxetine) on individuals who displayed mild symptoms of mental illness- but did not qualify for a DSM-IV diagnosis. The effects of the medication were measured through responses to several questionnaires over six months concerning mood, productivity, and anxiety. The results indicated that Prozac helped to ease the suffering of those individuals who had mild symptoms of mental illness. Individuals in this group showed a great improvement in mood and productivity and a lessening in their daily anxiety when compared to the control group. Healthy individuals who did not display mild symptoms of mental illness did not show improvement in anxiety, mood or productivity after taking Prozac for six months. These findings are congruent with the descriptions presented by Peter Kramer in Listening to Prozac. This study has significant implications for the field of Neuro -Ethics and enhancement. More specifically, if individuals who are suffering can be helped through the administration of medications then serious considerations must be made by health care professionals. Medicine aims to heal, and it is not the job of the psychiatrist to judge the amount of suffering felt by the patient. Rather, if psychiatrist encounter patients who do not qualify for a DSM-IV diagnosis, yet still have mild symptoms of mental illness then anti-depressants such as Prozac should be administered to them.


Use of Anti-Depressants for Individuals without a DSM-IV Diagnosis

A growing body of evidence suggests that using anti-depressants for individuals who do not meet the criterion for a diagnosis in the DSM-IV can help to make these individuals “better than well” (Kramer, 1993). Dr. Kramer, a psychiatrist prescribing Prozac to individuals who did not have a DSM-IV diagnosis (for example individuals who suffered only mild depression, or mild anxiety) found that often, Prozac could, “give social confidence to the habitually timid, to make the sensitive brash, to lend the introvert the social skills of a salesman” (Kramer, 1993). Kramer found that Prozac had a “transformative power – it went beyond treating illness to changing personality” (Kramer, 1993).

Such effects were never described by the scientists who initially studied Prozac. For these researchers, the purpose of Prozac was to treat individuals with persistent depression, thus this effect of the drug was examined during initial trials. Prozac is in a class of drugs known as the selective seratonin reuptake inhibitors (SSRIs), this drug works by maintaining a relatively high level of seratonin in the brain (Sperry, & Prosen, 1998). High levels of seratonin are associated with, “euthymic mood, sound sleep, appetite satiation, and pain relief” (Sperry, & Prosen, 1998). However, low levels of seratonin are associated with, “depression, anxiety, suicide, chronic pain, binge eating, insomnia, irritability and impulsive behavior” (Sperry, & Prosen, 1998). While Prozac is usually prescribed for individuals with mental illnesses from psychotic depression to schizophrenia these topics will not be dealt with in this paper. This paper also does not aim to belittle the significance of chronic and persistent mental illnesses such as major depression. Many individuals around the world suffer from major depression, however they are not the focus of this paper. Instead this paper will focus on the use of Prozac for individuals who do not suffer from any of these ailments.

In his first instance of using Prozac Dr. Kramer treated a women by the name of Tess, she was the eldest of ten children, and had been born to a very poor family (Kramer, 1993). Tess’ mother was very passive and her father was an alcoholic. When Tess was very young her father died, and her mother fell into a deep clinical depression, which she was never able to recover from (Kramer, 1993). However, Tess was able to excel - she remained in school, and was able to make a business career out of skills she already possessed (Kramer, 1993). Tess had a great deal of responsibilities, with work and her family- she still cared for her mother since she was quite ill. When interviewed about her symptoms Dr.Kramer found that Tess had an absence of hope, inability to experience pleasure, feelings of worthlessness, guilty ruminations, poor memory and concentrations (Kramer, 1993). Tess also struggled with her personal life and believed that she was unattractive to all men.

After being prescribed Prozac Tess no longer felt weary, she looked relaxed and energetic, she laughed more frequently she even started dating (Kramer, 1993). Tess even began to change her circle of friends saying that she had only related to her friends because they were all depressed. Finally, Tess moved away from the town where her mother lived and therefore was not able to take as close and careful care of her as she once had been able to (Kramer, 1993).

This use of Prozac and other anti-depressants to make people feel “better than well” has been termed “cosmetic psychopharmacology” (Kramer, 1993). While Kramer focused only on individuals with mild symptoms of depression further research studies have found that even individuals who were normal felt “better than well” when given an anti-depressant in a clinical trail (Healey, 2004). While “cosmetic psychopharmacology” does contain great promise for those who suffer from mild depression and other mild psychiatric illnesses - it is a topic filled with controversy. Many believe that Dr.Kramer treats psychological problems as headaches, “pains or deficiencies that give rise to particular modes of perception or cognition without being particular modes of perception or cognition themselves” (Parens, 1998). Freedman argues that emotional disturbances are not like headaches and therefore cannot be treated as such - they cannot be treated with drugs (Parens, 1998). Freedman believes that Kramer’s view on emotional disturbances poses a great ethical dilemma - where our view of the self as a responsible agent is put at risk (Parens, 1998).

Furthermore, Kramer’s view is troubling because it makes it too easy for people to see themselves in mechanistic terms (Parens, 1998). And thus this jeopardizes their own responsibility as people. According to Freedman, “we must struggle toward insight through dialogue” (Parens, 1998). Wyatt Brown, further supports this view when he writes that “pain and ordeal had their indispensable uses” (Bjorklund, 2005). Dostoevsky taught that “suffering is an evil, yet…through the ordeal of suffering one gets these strange benefits of lucidity of seeing things afresh” (Bjorklund, 2005). Many of those who question the ethics of cosmetic psychopharmacology refer to the fact that through experiences - even if they may be “bad” ones humans do learn a great deal. For example, if one suffers a great deal after a break up with a significant other, they may learn new coping strategies that will help them when they go through similar experiences later on in their life - one may also learn to appreciate “good” times in their life a great deal from these “bad” experiences.

Furthermore, recent studies have found that observing someone in pain activates the same neural circuits that are involved when one experiences pain (Chatterjee, 2006). One can thus infer from such studies that painful experiences are necessary to develop empathy (Chatterjee, 2006). To many sidestepping distress is somehow “cheap”, “struggling in some situations and experiencing distress and failure are quintessential aspects of human experience” (Chatterjee, 2006). While some believe that using Prozac and other such drugs for individuals without a DSM-IV diagnosis is changing essentially human experiences Kramer argues that what we believe to be essential, should change (Kramer, 2000). The concern that using anti-depressants for individuals without a DSM-IV diagnosis may change essential aspects of human experience is only one of many concerns.

Many fear that use of anti-depressants for “cosmetic psychopharmacology” will affect class differences in the United States. Medications that are used for cosmetic psychopharmacology are unlikely to be paid for by health insurance companies (Chatterjee, 2006). This means that only those that are wealthy will have access to these drugs - leaving the poor to use cheaper remedies such as coffee, booze, and cigarettes (Chatterjee, 2006). Since cosmetic psychopharmacology may lead to improved abilities, this unequal access to them will widen disparities that already exist (Chatterjee, 2006). Overall, cosmetic psychopharmacology is likely to benefit mainly those who are well off and advantaged. However, these concerns will not likely stop the use of pharmacological enhancement since in the United States there are already wide disparities in access to healthcare and education and these disparities are considered tolerable (Chatterjee, 2006).

Another worry concerning cosmetic psychopharmacology is that it promotes some troubling cultural values. Many seek out Prozac to become more efficient at work, or at school or to have a more attractive personality. Thus the use of Prozac for individuals without a DSM-IV diagnosis may cause for the society to value competition even more then it already does. Many worry that Prozac, “treats the self rather than proper diseases, that it alters personality, that it feeds dangerously into the American obsession with competition and worldly success and that it offers a mechanistic cure for spiritual problems” (Elliott, 2000). Our society is one which values cheerful individuals, resilience and assertiveness. According to Kramer, the expectations of our society “leave certain people difficult options: they can suffer, or they can change” (Kramer,1993). However, Kramer does not explore the possibility in his book that instead of changing people within our society, the focus should be on the expectations of society (Elliott, & Chambers, 2004). While this may be true, if there is a responsibility to change the culture that we live in - it is not just that of the psychiatrist but rather it is everyone’s responsibility.

The use of pharmacological enhancement also causes a great deal of concern which has to do with autonomy. This concern stems from the fact that what “starts out as a matter of choice ends up as a coercive force” (Chatterjee, 2006). This force may be implicit or explicit. For example, certain individuals may be expected to participate in pharmacological enhancement if it will benefit the greater good (Chatterjee, 2006). For example, if business companies realize that people who take SSRI’s like Prozac become more productive at work and more motivated as is described in Dr. Kramer’s book Listening to Prozac, it may be possible that CEO’s will force their employees to take these medications (Chatterjee, 2006). Financial incentives, and promotions may be offered to those who agree to take these medications. More implicit pressure could be found if workers at a large company realize that there are other who are taking Prozac because this has made them more motivated and better at their jobs- they may feel pressured that to compete with their co-workers or to be on the same level as them they must also take such medications (Chatterjee, 2006). Others argue that if everyone who wants to be more successful at work opts to use Prozac as a means to gain a competitive edge the results will be self-defeating (Elliott, & Chambers, 2004).

Many believe that taking Prozac is simply a “mood brightener”, and that it makes assertive and sunny individuals (Kramer, 1998). However, Kramer argues that it does not - Prozac does not make or mask moods (Kramer, 1998). Prozac does not keep people from seeing life the way it is rather he argues that, “it catalyzes the precondition for tragedy, namely participation” (Kramer, 1998). Prozac promotes, other-directed, social activities. Kramer believes that Prozac actually “increases personal autonomy” (Kramer, 1998). Kramer argues that Prozac does not transform individuals (Kramer, 1998). Instead, Prozac frees persons so that they can transform themselves.

Concerns for the use of anti-depressants for individuals without a DSM-IV diagnosis also stems from the fact that many believe that using Prozac is un-authentic (Degrazia, 2000). Carl Elliott claims that deliberately changing one’s personality through use of Prozac is inauthentic because it results in a personality and life that are not one’s own (Degrazia,2000). Elliot states, “it would be worrying if Prozac altered my personality, even if it gave me a better personality, simply because it isn’t my personality” , Elliot goes on to ask “what could seem less authentic, at least on the surface than changing your personality with an antidepressant?”(Degrazia, 2000). However, many argue that this view presents the “self” as static, and unable to change (Degrazia, 2000). According to David Degrazia, one can still be true to oneself even as one deliberately transforms and creates themselves (Degrazia, 2000). Degrazia argues that such cases of transformation as with the use of Prozac may be seen as enhancement, “interventions designed to improve human form or functioning beyond what is necessary to sustain or restore good health” (Degrazia, 2000). Some forms of self improvement, such as exercise or education are considered natural, or even admirable. However, other means such as the use of Prozac are considered artificial and involving a shortcut (Degrazia, 2000).

Elliot argues that the use of Prozac to drive changes in personality are un-authentic and lead to a personality that really isn’t ones own (Degrazia, 2000). This may be because it is believed that Prozac, creates the most extensive transformations of personality (Degrazia, 2000). In one view, a person’s “inner core”, the values that make up the individual are constructed by society (Degrazia, 2000). However, in the opposite view the self is malleable and can change. According to Sartre, “human beings are thrown into the world without any determinate nature. What we choose determines what we are, so we are completely responsible for what we become. With nothing except ourselves determining our actions and identity” (Degrazia, 2000). Therefore, we may shape ourselves into one form one day and into another form the next day. According to this view, we are completely self-creating. Self-shaping and self creation is possible, but it is limited by many other major process and factors that shape our lives (Degrazia, 2000).

To many people a life that is inauthentic, is one that is wasted. In living such a life people fail to meet their potential (Parens, 1998). For example, “a Gauguin who didn’t go to Tahiti, or perhaps closer to the mark, the life of someone who is play-acting at something he isn’t” (Parens, 1998). While there may be nothing wrong with such a life, it is not truly your life (Parens, 1998). This is at the root of many of the concerns about using Prozac for individuals without a DSM-IV diagnosis. If Prozac gives one a better personality - but this personality is not their own, it defies an ethic of authenticity (Parens, 1998). On the other hand, many Americans search for self-fulfillment in their lives; this can be achieved through a life of honest work (Parens, 1998). Thus, it makes sense to embrace a drug such as Prozac, which would offer the promise of doing better, more meaningful work in a happier, more enthusiastic way (Parens, 1998). In this way, many are torn as to what is the best way to approach the use of Prozac in our society.

In bioethics, the phenomenon that Kramer called ‘cosmetic psychopharmacology’ has been classified as an enhancement technology. Bioethicists have used the term “enhancement technology” as a way to describe all kinds of technologies whose uses go beyond strictly medicine (Elliott, & Chambers, 2004). There is a morally important distinction between enhancement and treatment. Treating illnesses is an essential part of medicine. Doctors must treat sick people, however enhancement is something extra - and not something a doctor has an obligation to provide (Elliott, & Chambers, 2004). However, the distinction between treatment and enhancement is much more elusive in psychiatry. “Where is the line between psychopathology and social deviance, perversion or eccentricity? When does shyness turn into social phobia, or melancholy into depression?” (Elliott, & Chambers, 2004). This problem is complicated further by the fact that very little is known about the human mind. Many philosophers have argued that illness is a departure from species -typical human functioning (Elliott, & Chambers, 2004). However, this offers little help when we think about the human mind and human behavior (Elliott, & Chambers, 2004).

Several ethical issues arise when one considers enhancement technologies or ‘cosmetic psychopharmacology’. One such issue is that many argue that some means of personal self - improvement such as exercise, education and prayer are “natural” while other means are “artificial” (such as taking drugs like Prozac). Eric T. Juengst argues that “Personal improvements should be earned by discipline and effort…and to acquire them through biomedial interventions is to cheapen their value and cheat the social practices in which they play a role” (Parens, 1998). Furthermore, many view the use of such biomedical interventions as “playing G-d” or “pharmaceutical Clavinism” (Parens,1998).

Furthermore, enhancement is often viewed as artificial. Many view that the pharmaceutical shortcut to happiness is wrong because it is “artificial” while traditional ways of making yourself happier such as exercise, prayer and education are acceptable because they are “natural” (Parens, 1998). Such an argument is often used by those who are involved in religion or theology. Using biomedical means to improve oneself is to “play G-d” (Parens, 1998). For psychologists, those improvements that are deemed “natural” are considered to be more “authentic” and therefore they are seen as better and more preferable than those that are artificial. For those within religion, the “naturalistic interpretations of the distinction may serve as useful moral signposts” (Parens, 1998). However, for others, it is difficult to ‘operationalize’ naturalism for public policy, “What should the state make of this claim in which educational regiments, religious rituals and the conventions of sports are playing the role of the “natural” while empirical observations, biological materials and organic chemicals are labeled as artificial?” (Parens, 1998).

Another ethical issue arises when one considers the view of enhancement as a corrosive shortcut (Parens, 1998). Biomedical enhancement, has been viewed as a form of cheating (Parens, 1998). According to Juengst, this view assumes that “taking the biomedical shortcut somehow cheats or undercuts the specific social practices that would make the analogous human achievement valuable in the first place” (Parens, 1998). For this reason, some argue that, it defeats the purpose of the contest for the marathon runner to gain endurance chemically rather than through training, or it defeats the purpose of meditation for someone trying to gain Nirvana through meditation to gain it through psychosurgery - or in the case of this study it defeats the purpose for an individual without a medically diagnosed mental illness to take Prozac (Parens, 1998). Juengst, believes that “the achievement- successful training or disciplined meditation - add value to the improvements because they are understood to be admirable social practices in themselves; whenever a corporeal intervention is used to bypass an admirable social practice then the improvement’s social value is weakened accordingly” (Parens, 1998). In order to preserve the value of social practices that count as “enhancing” it is necessary to impose a means - based limit on biomedical enhancement efforts (Parens, 1998). Such a view of this ethical issue emphasizes the challenge that enhancement poses for one’s own moral integrity; individuals may wonder to what extent they can take credit for their accomplishments (Parens, 1998).

Furthermore, this interpretation of enhancement has implications for policies of the social institutions that maintain practices that are valued in our society (Parens, 1998). According to Juengst, “ to the extent that biomedical shortcuts increasingly allow specific accomplishments to be divorced from the admirable practices they were designed to signal the social value of those accomplishments becomes undermined” (Parens, 1998). Jeungst believes that it will not only be the intrinsic value that will be diminished for all those that take the shortcut, but the resulting disparity between the enhanced and unenhanced will cause the fairness of the whole institution in question be called into question (Parens, 1998).

Finally, an ethical issue also arises when one realizes that the use of Prozac for individuals without a DSM-IV diagnosis may be a way of medicating a social problem (Parens, 1998). The improvement of traits such as loyalty, competitiveness, leadership and stewardship was once the work of teachers, ministers, coaches, and counselors. However, when we shift to having doctors fix theses traits medicine runs into a “basic epistemic boundary” (Parens, 1998). It is not clear how one can identify “any optimum or even maximum conditions for social traits through medical means alone” (Parens, 1998). According to Jeungst, “if a criteria drawn from other spheres of experience seem like better measures of improvement than medical measures, then the intervention in question should probably count as an enhancement that goes beyond medicine’s domain of expertise” (Parens, 1998). It is argued that biomedicine should focus on work with “bodily dynamics” and leave “social dynamics” to others (Parens, 1998).

While Peter Kramer’s Listening to Prozac provides many examples of the effects of treating individuals who do not have a DSM-IV diagnosis with Prozac there are no controlled experiments on this topic. The current study aims to replicate Kramer’s observations in a controlled environment. This study is significant because no others like it exist in the literature - it will provide statistical data upon which further conclusions and implications may be drawn. The purpose of this study is to compare the effects of Prozac on individuals that do not have any symptoms of mental illness with those who have mild symptoms of mental illness but do not qualify for a diagnosis in the DSM-IV. It is believed that for individuals who do not have mild symptoms of mental illness their ratings of anxiety, mood and productivity will not change after taking Prozac. However, when individuals who have mild anxiety, sadness or compulsions but do not qualify for a DSM-IV diagnosis are given Prozac their ratings of anxiety, productivity and mood will improve.

Methods


Subjects

Two-hundred young adults (100 women and 100 men, mean age = 23.5) volunteered to participate. Volunteers were recruited through fliers hung around the Columbia University campus, along with ads in local news papers. Half of the participants were healthy young adults who did not suffer from any kind of symptoms of mental illness. The other half of the participants were young adults who suffered mild symptoms of mental illness such as anxiety, depressed moods, and obsessions or compulsions, however did not qualify for a DSM-IV diagnosis. This was determined by a licensed psychiatrist upon first meeting with the participants.



Procedures

Upon initially visiting the lab, participants who complained of mild symptoms of mental illness were evaluated by a psychiatrist to make sure that they did not qualify for a DSM-IV diagnosis. Half of these individuals then received a one month supply of 20 mg of Prozac, while the other half of these individuals received a placebo pill. The healthy individuals were not evaluated by a psychiatrist. Half of these individuals also received a one month supply of 20 mg of Prozac, while the other half received a placebo pill. Individuals were asked to come to the lab once a month for the next six months. At each of the following visits participants were asked to see a psychiatrist who would evaluate any side-effects, and also fill out questionnaires (Appendix 1) regarding their mood, productivity, and anxiety level.



Ethical Considerations

All individuals within the study signed an informed consent form prior to the study; this form would include information on the risks associated with taking Prozac and participating in the current study, the purpose of this study, and the fact that participating in the study is completely voluntary. Furthermore, individuals would clearly understand that all information provided to the psychiatrist or research assistants during the time of the study (ex- responses to questionnaires, information from the first evaluation with the psychiatrist) would be kept completely confidential, only those associated with the research would have access to this information.

Results

Individuals who suffered mild symptoms of mental illness but did not qualify for a DSM-IV diagnosis who were given 20 mg of Prozac for six months showed an increase in mood, and productivity and a decrease in their anxiety level as compared to individuals who suffered mild symptoms of mental illness and were given a placebo (tables one and two). Such an improvement was not seen in individuals who did not show any symptoms of mild mental illness and were given 20 mg of Prozac for six months. Their anxiety did not decrease, nor did their mood or productivity increase when compared to healthy individuals taking the placebo (table three and four).


Table One-Average Initial Ratings of individuals experiencing mild-symptoms of mental illness

Mood Productivity Anxiety



Prozac-20 mg

1.5

2.0

1.4

Placebo

1.8

1.9

1.8

The average ratings in the table above were found from surveys completed after Prozac or the placebo been administered for one month to individuals who had mild-symptoms of mental illness but did not qualify for a DSM-IV diagnosis.


Table Two-Average Ratings After Six Months of individuals experiencing mild-symptoms of mental illness

Mood Productivity Anxiety



Prozac-20 mg

4.7

3.8

4.2

Placebo

1.8

1.9

1.8

The average ratings in the table above were found from surveys completed after Prozac or the placebo been administered for six months to individuals who had mild-symptoms of mental illness but did not qualify for a DSM-IV diagnosis.


Table Three-Average Initial Ratings of healthy individuals

Mood Productivity Anxiety



Prozac-20 mg

4.4

4.8

4.4

Placebo

4.5

4.1

4.2

The average ratings in the table above were found from surveys completed after Prozac or the placebo been administered for one month to individuals who did not display any symptoms of mental illness.


Table Two-Average Ratings After Six Months of healthy individuals

Mood Productivity Anxiety



Prozac-20 mg

4.7

4.6

4.2

Placebo

4.4

4.2

4.0

The average ratings in the table above were found from surveys completed after Prozac or the placebo been administered for six month to individuals who did not display any symptoms of mental illness.


Discussion

The findings of the current study have important implications for psychiatry, public policy and our society. Since individuals who had mild symptoms of mental illness but did not qualify for a DSM-IV diagnosis showed a great improvement in symptoms such as anxiety, mood and productivity when given Prozac psychiatrists should be made aware of these effects. The Food and Drug Administration (FDA) along with policy makers should approve the use of Prozac and other anti-depressants for individuals with mild symptoms of mental illness.

The current study adds a great deal to the field since a study such as this had never been done before. However, many ethical issues and questions remain un-solved. For example, there are two perspectives on the human condition. In one view, “life is not meant to be a state of continuous happiness, contentment, and well-being. In fact, life is largely a struggle filled with pain, disappointment, grief, mourning, and sadness” (Sperry, & Prosen, 1998). In the other view, “life can and should be as fulfilling and actualizing as possible. Pain, anxiety, sorrow, and sadness are symptoms that can and should be alleviated with whatever means possible” (Sperry, & Prosen, 1998). The interpretation of the results of the current study depends which of the above views on the human condition one agrees with. According to the first view, the use of medications like Prozac for individuals without a DSM-IV diagnosis will, “rob life of its edifying potential for tragedy, in other words, the experience of pain, fear, grief, anxiety, and profound sadness is the experience of being human; and these states must be embraced rather than spurned or alleviated by psychoactive substances” (Sperry, & Prosen, 1998). This view implies that any use of SSRIs like Prozac for individuals with mild symptoms of mental illness is suspect, and can even be seen as de-humanizing. The use of Prozac is suspect because a medication accomplishes a basic function of psychotherapy and it is dehumanizing that an “intimate interpersonal function is accomplished by a pill rather than a person” (Sperry, & Prosen, 1998). The greatest concern in this view of the human condition is that Prozac will diminish the individual’s experience of sadness, which is believed to be “morally and developmentally necessary” (Sperry, & Prosen, 1998).

The other view of the human conditions, “ is centered on the belief that suffering in and of itself does not engender human growth and self transformation” (Sperry, & Prosen, 1998). In this view encouraging suffering is considered sadistic rather than transformative (Sperry, & Prosen, 1998). According to this view, feelings such as grief, shame and sadness are not uniquely human rather how people respond to them is, “medications like Prozac may allow us to be more creative and alive, and may even change the sort of evidence we attend to, in changing our sense of constraints on human behavior, in changing the observing self” (Sperry, & Prosen, 1998). This is the greatest ethical consequence of using drugs such as Prozac for individuals who do not have a DSM-IV diagnosis. Further research must be done to discover whether feeling emotions such as sadness, pain and anxiety are a necessity for the human condition. Many believe that certain traits such as irritability, and nervousness reflect one’s personality or temperament and are part of the basic human condition. However, new research suggests that irritability is actually a symptom of seratonin deficiency which can be alleviated by increasing the amount of seratonin in the brain (Sperry, & Prosen, 1998). This can be accomplished through natural methods such as increasing certain fats in ones diet or by the use of drugs such as Prozac. Thus, traits that were once assumed to be a part of the human condition may actually be a “symptom of biochemical deficiencies” (Sperry, & Prosen, 1998).

An ethical issue concerning the use of Prozac for individuals without a DSM-IV diagnosis centers around the fact that these individuals may be taking a “corrosive shortcut” (Parens, 1998). This view may be somewhat supported with the results of the current study. Instead of suffering through certain situation and certain emotions individuals taking Prozac easily bypass these struggles. However, for the most part, the individuals taking Prozac are not looking for a “shortcut” rather they are looking for a way to relieve what feels like suffering to them. Prozac helps these individuals to achieve a state of mind where they are not plagued by anxiety, sadness or compulsions and to them this doesn’t feel like a corrosive shortcut but rather a form of normalcy.

A final ethical issue is that the use of Prozac for individuals without a DSM-IV diagnosis may be a way of medicating a social problem (Parens, 1998). The results of the current study do not add to the debate for this ethical issue. Further research must be done to explore whether other social problems are underlying the mild symptoms of mental illness felt by individuals. In a future study investigating whether social causes may be the underlying reason that individuals have mild symptoms of mental illness, it may be important to thoroughly interview subjects in the study. In such an interview, subjects would be asked many questions about their lives, and about different pressures that they may face. For example, if a subject admits that much of the anxiety he or she feels is due to pressure at work - in this case doctors may be using Prozac to treat a social problem.

There were several limitations in the current study. For example, only young adults participated in this study. To gain a broader understanding of the effects of Prozac on individuals without a DSM-IV diagnosis it is necessary to use participants who represent many different age groups. Thus in future research it would be important to look at participants of all different ages (for example - young adults, children and adults). Also, the current study did not account for socio -economic status. However, since mental illness has been found to be more prevalent in low -income populations this factor should also be taken into account in future studies (Caron, 2010). For example, in a future study it will be important to make sure that both high and low - income individuals are represented in all groups.

As previously mentioned, it is necessary to conduct future research to understand whether emotions such as sadness, pain and anxiety are a necessity for the human condition. Such a study would need to take place over the long term - the design would be very similar to this study however subjects would be much younger than those used in this study (adolescents instead of young adults) and the study would last for several years instead of six months. Along with the questionnaires completed during the current study individuals would also complete questionnaires about scenarios that they would watch on a computer (having to do with empathy, sympathy, and emotions) such questionnaires would help the researchers to understand whether sadness, pain and anxiety are necessary for the development of the human condition.

Based on the current research study, drugs such as Prozac should be approved for use by individuals without a DSM-IV diagnosis. However, it will be necessary to gain information from further research studies to understand the extent to which these medications should be used. For example, if future research studies discover that Prozac is actually being used to treat social ills rather than to treat mild symptoms of mental illness - then policies would need to be adjusted to account for this. This study addressed the topic of using anti - depressants for individuals without a DSM-IV diagnosis. The results indicated that Prozac helped to ease the suffering of those individuals who had mild symptoms of mental illness. Individuals in this group showed a great improvement in mood and productivity and a lessening in their daily anxiety when compared to the control group. Healthy individuals who did not display mild symptoms of mental illness did not show improvement in anxiety, mood or productivity after taking Prozac for six months. This research lends support to the notion that anti - depressants such as Prozac should be used to treat individuals who have mild symptoms of mental illness. An ethically guided approach to this issue should include further research on whether Prozac is being used to treat a “social ill” and whether emotions such as sadness, anxiety and pain are necessary for the development of the human condition.
Appendix 1

Mood-Productivity-Anxiety Questionnaire

Directions: Please try to answer the following questions as honestly as possible. When you are done please give this questionnaire to the research assistant. Thank you!
Mood
Do you feel like your mood has improved since you began taking your medication?
1 2 3 4 5

Strongly Agree Strongly disagree


I feel hopeless on a daily basis- sometime I don’t even know why I feel this way.
1 2 3 4 5

Strongly Agree Strongly disagree


I get tired for no reason.
1 2 3 4 5

Strongly Agree Strongly disagree


I have crying spells- or I feel like I want to have them
1 2 3 4 5

Strongly Agree Strongly disagree


Productivity

Do you feel like your productivity has improved since you began taking your medication?


1 2 3 4 5

Strongly Agree Strongly disagree


It is hard for me to concentrate at school/work and stay “on task”.
1 2 3 4 5

Strongly Agree Strongly disagree


I have trouble planning in what order things should be done
1 2 3 4 5

Strongly Agree Strongly disagree


I often make quick decisions without thinking about the long term effects
1 2 3 4 5

Strongly Agree Strongly disagree



Anxiety

Do you feel like your anxiety has improved since you began taking your medication?

1 2 3 4 5

Strongly Agree Strongly disagree

I tend to focus on upsetting situations and events happening in my life.
1 2 3 4 5

Strongly Agree Strongly disagree


When someone snaps at me I spend the rest of the day thinking about this
1 2 3 4 5

Strongly Agree Strongly disagree


I often feel nervous and overwhelmed when there is no clear reason for me to feel this way.
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Strongly Agree Strongly disagree



References
Bjorklund, P. (2005). Can there be a 'cosmetic' psychopharmacology? Prozac unplugged: the search for an ontologically distinct cosmetic psychopharmacology. Nursing Philosophy, 6, 131-143.
Caron, J. (2010). A descriptive study of the prevalence of psychological distress and mental disorders in the canadian population: comparison between low-income and non-low-income populations. Chronic Diseases in Canada, 30(3), 84-94.
Chatterjee, A. (2006). The promise and predicament of cosmetic neurology. Journal of Medical Ethics, 32, 110-113.
Degrazia , D. (2000). Prozac, enhancement, and self-creation. Hastings Center Report, 30(2), 34-40.
Elliott, C, & Chambers, T. (Ed.). (2004). Prozac as a way of life. Chapel Hill, NC: The University of North Carolina Press.
Elliot, C. (2000). Pursued by happiness and beaten senseless. Hastings Center Reprot, 30(2), 7-12.
Healy, D. (2004). Let them eat prozac. New York,NY: New York University Press.
Kramer, P. (1993). Listening to prozac. New York,NY: Penguin Books.
Kramer, P. (2000). The valorization of sadness alienation and the melancholic temperament. The Hastings Center Report, 30(2), 13-18.
Parens , E. (Ed.) (1998). Enhancing human traits: ethical and social implications . Washington, D.C.: Georgetown University Press.
Sperry, L, & Prosen, H. (1998). Contemporary ethical dilemmas in psychotherapy: cosmetic psychopharmacology and managed care. American Journal of Psychotherapy, 52(1), 54-63.

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