Aplastic anemia linked to Prozac

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Aplastic anemia linked to Prozac

After years of being touted as the "happy pill," the truth about the anti-depressant fluoxetine (Prozac) is beginning to surface. Now, another serious side effect has been linked to the drug.

According to information published in The Lancet, a 28-year-old man who had been taking Prozac for obsessive-compulsive disorder developed aplastic anemia -- a disease that impairs the ability of bone marrow to generate blood cells.

Other causes of aplastic anemia are radiation, as well as some chemicals and drugs, but this is the first case believe related to Prozac.

The symptoms of aplastic anemia stem from low levels of blood cells. The disorder leads to decreased amounts of red blood cells, resulting in anemia; decreased amounts of white blood cells, leading to an increased risk of infection; and falling platelet counts, which lead to impaired clotting.

The patient was admitted to Hospital Casa Maternitat, Barcelona, Spain, after experiencing painful mouth ulcers, a high fever, and chest pain for six days. A blood test showed that he had marked reductions in red blood cells, white blood cells, and platelets, according to his physicians, Drs. Xavier Bosch and Manel Vera, who described the unusual case in the April 4th issue of The Lancet.

Bosch and Vera conducted bone marrow testing, which also showed abnormal results. They gave the patient intravenous antibiotics, and his symptoms improved rapidly. However, his blood counts did not recover completely until 19 days after his hospital admission.

The only drug the patient had been taking prior to being admitted to the hospital was fluoxetine, 20 milligrams twice daily for six weeks. On the patient's third day in the hospital, Bosch and Vera replaced fluoxetine with clomipramine, another antidepressant, which he responded to.

To test whether the patient's anemia was related to fluoxetine, Bosch and Vera reinstituted that drug on the 25th day after admission. Within five days, the patient's blood counts dropped once more, and the doctors again had to substitute clomipramine for fluoxetine. The patient's blood cell counts returned to normal 12 days later.

For the next six months, the patient continued to take clomipramine, and Bosch and Vera reported that he continued to be symptom-free.

"To the best of our knowledge, our case constitutes the first report of aplastic anemia related to fluoxetine," Bosch and Vera wrote. "The sequence of related events...is highly suggestive of fluoxetine-induced bone-marrow failure."

"This on-off-on is convincing," Dr. Gary Sachs, an assistant professor of psychiatry at Harvard Medical School, told Reuters. "This person is in fact sensitive to Prozac."

The common side effects of Prozac are related to its stimulant effects, Bosch and Vera noted. About 10% to 25% of patients taking Prozac experience "nausea, nervousness, insomnia, headache, tremor, dry mouth, sweating, and diarrhea."

In an interview with Reuters, Greg Kueterman, a spokesperson for the drug's manufacturer Eli Lily and Company, tried to defend the drug, saying that if aplastic anemia is in fact related to the drug, it appears to be "very rare."

However, even a so-called "rare" side effect can affect thousands of people when a drug is taken on the scale of Prozac. More than 31 million people globally have used Prozac, including 22 million in the United States. It is one of the most commonly prescribed medications in the world despite increasing evidence that it has negative side effects -- and even a new study that shows its real benefits might be minimal. See page 6 for more information on that research.

Source: The Lancet 1998; 351:1031.

The Chiropractic Journal.

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