The mothers who pop Prozac

Early parenthood is stressful, but can a `wonderdrug' help? Deborah Holder talks to women who have tried it

"For the first time in years I kept getting wolf whistles. I seemed to be followed by car beeps and pick-up lines wherever I went. I didn't feel like a mum; I had an extra spring in my step. But how I am and how I was coming across were different. It was an unrealistic and superficial confidence."

This is how Lynn, a 34-year-old mother of two, remembers her six months on the anti-depressant drug Prozac. For exhausted parents, it can be a tempting prospect. If you're low and demoralised, ground down by the constant demands of motherhood, it can lift you. Can't face getting out of bed for the school run? It will motivate and re-energise you. When all you do is bicker with your partner, whose independent life seems so far removed from your house-bound one, it relaxes you, taking the edge off your resentment.

The years spent with children under five are tough. With people starting families later, a new family often coincides with crucial career years during the mid thirties. A mother may be working part-time in an attempt to keep a career on the back burner for the future, or struggling to work full-time as well as taking care of her home, kids and relationship. Alternatively she may be at home full-time, slowly disappearing beneath a never-ending pile of dirty T-shirts and broken toys. Her husband will also be working through one of the most demanding periods of his career, rarely home before the kids go to bed and working odd weekends. He feels stressed out by work, excluded from family life and let down by a partner too tired to cook late-night dinners and listen to him offload about work. She feels isolated and finds it hard to sympathise with his needs when she's too tired to keep her eyes open for the nine o'clock news. Sex becomes at best a distant memory, at worst a destructive bone of contention. Not surprisingly, many relationships don't survive the toddler years. Of course it isn't like this for everybody, but it is for some. And if Prozac can help, what's the problem?

Since its UK debut in1989, Prozac has attracted more than its fair share of attention. Despite the hype, health experts insist it is no different from other anti-depressants of its type, with one important exception - you can't kill yourself with an overdose. But if the experts are unimpressed, it certainly seems to be hitting the spot with the public. Department of Health's figures for 1994 show 1.4m people in England were prescribed Prozac by their GP (this excludes cases of clinical depression being treated in hospitals and psychiatric units.) The projected figure for 1995 is 2m. Two-thirds of Prozac users are women, a reflection of the gender split in diagnosed depressives; many of those are mothers of young children, a group consistently shown to experience higher levels of depression.

There is little doubt that Prozac can be life- changing for those whose lives are blighted by recurring bouts of clinical depression. Whether it can also help people brought down by the circumstances of their lives is less clear. The question is whether Prozac is being inappropriately prescribed and can actually exacerbate the problems of those who take it. Dr Richard Tyner, chairman of the prescribing committee and a GP, is confident clinical depression can be clearly indentified. "A GP will ask key questions - is there weight loss, early-morning waking, loss of appetite, loss of libido, sustained feelings of not being able to cope? - and decide whether Prozac is appropriate.

Like other experts, Tyner recommends counselling alongside use of Prozac. In reality, though, this rarely happens. Julia Cole of Relate explains that some women only make it to counselling when they face the "reality crash"associated with coming off Prozac and returning to the problems that put them there in the first place.

The other question is whether Prozac's potential side-effects are being adequately explained to patients and monitored by their GPs. Many mothers might decide against Prozac if better informed. Prozac is no longer new, but there is surprisingly little research on its use and psychological effects. Much of what does exist is confidential, forcing the media to fall back on anecdotal evidence. The Committee on Safety for Medicine, for instance, has figures on prescribing patterns as well as GPs' views on Prozac - but they are confidential. Manufacturer Eli Lilly buys in market research information, but regards it as "sensitive data" not for public consumption. GPs, pharmacologists and other health professionals are extremely reluctant to go on record about a particular brand.

Despite the newly acquired spring in her step, Lynn stopped taking Prozac after worries that it impaired her judgement. "Prozac gave me unrealistic levels of confidence about my life - a sort of `Everything is going to be alright' feeling when things were actually getting worse. It stopped me dealing with matters that were important. There were more specific things, too. I answered an ad for part-time work training race horses. If I saw that ad now I'd think: `Lynn, you're 31, haven't ridden for donkey's years - and who'd take care of the kids if something happened?' But at the time it seemed like a great idea. I didn't think about the risks. The guy gave me the job over the phone, which shows how confidently I came across."

Many psychologists argue that this isn't new. Certain anti-depressants have always been mood- altering, and some people are more sensitive than others. Psychologists argue that if Prozac is different, it's because the public believe it is. Media hype means they are more prepared to take it and believe that it can work for them. And so it does.

However, many women report strikingly similar feelings of over-confidence and poor judgement. Some said they would be reluctant to tell their GP about their uncharacteristic behaviour on Prozac for fear of being seen as unfit mothers. "On the one hand I was much more patient with the kids," says Elsa, 36, "because I didn't have loads of problems buzzing around in my head. At the same time I'm sure I used seat belts less than before. It's not necessarily a good thing to be so relaxed and confident when you're responsible for a couple of kids." Like many women, Elsa stopped taking Prozac because it didn't help her deal with her problems. It merely changed her perception of them.

"In some cases Prozac can help you struggle through," says Dr Valerie Curran, a clinical psychologist and psychopharmacologist at University College London, "but it obviously doesn't address the cause of the depression." Nevertheless, Curran believes it can help some women: "Social support networks like the extended family have disappeared; work culture is more macho. Stress on parents has increased, and if a mother is depressed if affects the children's well-being, too."

Many mothers may not be depressed, but the feelings associated with depression - isolation, low self-esteem, hopelessness - are familiar. Women who previously received positive feedback and support through a career or relationship suddenly find parenting is not valued. Without affirmation or a role by which to define themselves, people's sense of identity can be tenuous - and mothers understand this better than most.

Can Prozac help? The problem is that it is just a pill, and pills can't discriminate between the bits of a person's life they want to be insulated from and the bits they need to view clearly. It has no filter mechanism. If it makes you feel better about one thing, it makes you feel better about everything. Given that it is often prescribed in extreme situations - when a relationship has reached crisis point, for example - feeling better about everything may not be helpful. Perhaps your relationship is destructive and needs to end; perhaps a child's bedwetting is actually a serious problem.

If there are real problems, you need to know they are real - and you have to make the right decisions in dealing with them. Prozac may work miracles if the obstacle is internal, but if it is situational then you need to change the situation and not just your perception of it. Maybe you need to bin the Prozac and hire a cleaner. !

A SOFT-FOCUS VIEW OF A MARRIAGE IN CRISIS Lydia, 32, is the mother of two girls age two and three. Last year she divorced Phil, her husband of eight years. The relationship had been in crisis for two years but the final straw came when Phil had an affair with a work colleague. For their last six months together, when the affair took place, Lydia was taking Prozac. This is her story.

"I couldn't get up in the morning and felt totally depressed about my life. My GP asked about my marriage and I said we had serious problems. To his credit, he did suggest Relate first. But I had already asked Phil to go, and he had flatly refused. The alternative was Prozac. I couldn't afford acupuncture.

"The immediate effect was very noticeable. I remember walking past a mirror and seeing myself smiling about nothing in particular for the first time in ages. I was more patient with the kids and had a lot more energy for day-to-day stuff. I had completely lost my motivation, and that returned in large measure. I'd felt tired for so long; it was great to have energy again. I was sleeping badly, but that didn't seem to make a difference. I was cleaning and dusting like a Stepford wife. I started thinking about getting a job. I had a lot of ideas but they weren't very practical.

"I'd occasionally think, `I can't stay on this stuff forever. We've got to resolve our problems.' But mostly I didn't worry about them. Emotionally, that worked. Logically, though, I knew the problems would still be there when I came off it.

"Phil was quite happy for me to continue on Prozac. For him it was the solution. I'm sure I was easier to live with on it. We certainly didn't row so much. To say it's non-addictive is misleading. You don't want to stop because you know all the old problems are waiting for you when you do. In my case the problems escalated and Prozac interfered with my ability to deal with them.

"After a few months we were at a work party of Phil's. I sat on the sidelines and watched my husband dance with and then kiss a mutual friend. I sat and watched and didn't react, which is something I'd never have done under normal circumstances. I'd lost touch with my emotions. I thought: `Well, that doesn't bother me, so I can't love my husband that much.' I let everything happen in front of me as if I was watching a film. I'd lost my gut reaction. If I'd taken it as seriously as I should have done, I'd have reacted differently. I was detached, blase, unworried about the future when I should have been.

"An affair developed from there and I ignored it. The marriage may well have ended anyway. We had very different ideas about how to bring up kids, what a relationship should be - but I think we should have been facing up to these things, not just ignoring them."