Prozac has played a big part in reducing the stigma attached to depression, making it easier to talk about, writes Peter Kelly…
In the early 1990s the US crime rate had been on a steep upward climb since the 1960s. In 1960 there was 482 murders in New York City and it gradually increased years to a peak in 1990 of 2,245 murders.
And then to everyone’s surprise it started to fall and by 2017 there were 290 murders in New York City.
Many interesting theories have been put forward over the years as to why this drop in violent crime happened. The drop did not occur just in New York City. It occurred throughout the United States.
The most famous and controversial theory was put forward by Steven Lewitt and Steven Dubner in the book Freakonomics. They argued the drop was due to the legalisation of abortion in the 1970s.
They argued that many who would be neglected children and potentially grow up to be criminals were not born and thus the reduction in crime and violent crime.
In the book Tipping Point, Malcolm Gladwell argues that police tactics and the broken windows theory led to the reduction in violent crime. The broken windows theory states that visible signs of crime, anti-social behaviour and civil disorder create an urban environment that encourages further crime and disorder including serious violent crime.
Thus, by targeting minor crimes like vandalism, public drinking and fare dodging on public transport, police create an atmosphere of law and order that reduces serious crime as well as minor crime. Mayor Rudy Giuliani famously introduced these types of policing policies when he was mayor in the 1990s.
Another theory suggests that the removal of lead from petrol used in cars led to the reduction in violent crime. Lead is believed to lower intelligence and increase aggression levels. A strong correlation was found demonstrating that violent crime rates in New York City and other big cities began to fall after lead was removed from American gasoline in the 1970s.
One of the latest theories for the reduction of violent crime in the 1990s in American cities is the widespread ownership of mobile phones. It is argued that mobile phones changed the drug trade. The argument goes that drug dealers once sold their drugs on their ‘turf.’
This need to own and control an area from which to sell their wares freely led to turf wars and violent and revenge attacks. Once mobile phones became ubiquitous, dealers could arrange met ups with their customers anywhere and everywhere and the need to control turf disappeared, thus reducing turf wars and violent crime.
Other theories put forward include economic growth and the reduction in alcohol consumption.
I have often wondered whether Prozac played a role in this reduction in violence. We know that depression is linked to suicide. When people are depressed they are more likely to have suicidal thoughts and they are more likely to commit suicide.
Suicide is a violent act. Is it possible that when people are depressed, they are more likely to have homicidal thoughts and are thus more likely to commit a homicidal act.
Of course, I know this is only anecdotal evidence but over the years I have spoken to patients in the pharmacies I have worked in who have committed violent acts in the past and they all said something all the lines of ‘I was in a very bad place at that time. Looking back now I can see that I was very depressed and/or suffering from other mental health issues.’
The timeline for Prozac is interesting too. While Fluoxetine was discovered by Eli Lilly and Company in 1972, it did not appear on the US market until January 1988. Straight away it was a huge commercial success. Annual sales of Prozac reached $350 million within one year.
The introduction of Prozac led a lot more people to think about depression, to talk about depression and to seek treatment for depression. It led to other antidepressants coming to market such as sertraline, citalopram and escitalopram.
A NBER study examining international trends in antidepressant use and crime rates in the 1990s found that increases in antidepressant drug prescriptions were associated with reductions in violent crime.
When you work in health and you help treat people with conditions like depression, you often feel you are just helping them but you are also helping the wider community. And that is why fighting for mental health services is so important.
Could the reduction of mental health services in the UK be linked to the increases in knife crime?
It is sometimes very easy to be critical of drug companies and medicalisation but on balance maybe it is a positive thing for society.
Depression is openly talked about throughout the media now. There is far less stigma attached to depression and other mental health illnesses now than in the past and that is a good thing.
Prozac and its marketing team played a big part in that normalisation of talking about depression and treating depression and that may have helped our cities and communities become less violent.
Peter Kelly is a community pharmacist based in London and occasional stand-up comedian.