The BBC's Karen Bowerman reports on the success of 'the miracle drug'

Initially hailed as a miracle cure, the drug has received a mixed report.

Some doctors raised fears that it was addictive and linked to suicidal thoughts.

There was also concern that the drug was being used by people who were not suffering from clinical depression, but who wanted a "quick fix".

Those concerns have led to several US health maintenance organisations using alternative modern anti-depressants from the same class as Prozac - the SSRIs, or selective serotonin reuptake inhibitors.

However, depression expert Dr Andre Tylee, a GP in Sutton, Surrey, said that Prozac is now routinely prescribed by GPs to patients who exhibit the signs of major depression.

Approximately one million people in the UK now take the drug, and sales run at approximately �100m a year.

In a practice of 2,000 patients this can be as many as 100 patients at any given time.

Depression has many symptoms

"Prozac has revolutionised the treatment of clinical depression in primary care," said Dr Tylee, one of the organisers of the national Defeat Depression Campaign launched by the Royal College of General Practitioners.

"Prior to Prozac there were older drugs available that had more side effects and were less safe.

"But with Prozac we had a medication that was safe, easily tolerated and easy to take, and which effectively helped to reduce the symptoms of clinical depression in a way that enabled us to improve the effectiveness of the talking treatments as well."

Dr Tylee said the medical approach to treating depression was to offer "pills for the symptoms and talk for the problems".

The talking therapies include:

• Problem solving: Used to help patients tackle soluble problems in their lives;
• Coping stategies: To help patients deal with problems that can not be easily solved;
• Cognitive therapy: For use with patients who exhibit persistent and automatic negative thoughts about life. This helps patients to substitute a more appropriate thought for the negative feelings they may experience;
• Behaviour therapy: Designed to encourage people to try something new as way to overcome their depression.

Dr Tylee said he would always consider Prozac for patients who exhibited signs of major depression.

This he defined as a combination of symptoms exhibited every day for a period of at least two weeks.

Symptoms include:

• Persistent feelings of sadness, emptiness, despair and irritability;
• Loss of pleasure from activities previously enjoyed;
• A change in weight or appetite;
• Sleep disturbance, including over-sleeping;
• Feelings of guilt and helplessness;
• A lack of self-worth;
• Inability to concentrate;
• Excessive worry or anxiety;
• A reduction in energy or libido;
• Thoughts of death or suicide.

Dr Tylee estimated that approximately 5% of the population suffered from the symptoms of major depression at any one time.

He said that every day one or two people who attended his surgery exhibited symptoms.

Stigma lingers

However, there is still stigma associated with depression. Approximately 50% of sufferers do not seek help from their GP.

A survey conducted by ICM for the drug's makers Eli Lilly and Co found that although 75% of women regarded depression as a serious illness only 52% would be prepared to take Prozac as a treatment.

Dr Allan Young, Honorary Consultant Psychiatrist at Newcastle General Hospital, said: "Ten years ago people had a very poor understanding of depression and consequently, society attached considerable stigma to it.

"Not only was the introduction of Prozac a medical advance but its popularity has helped lead both to an increase in the awareness of depression and the number of patients who are prepared to seek help.

"Now we need to work towards destigmatisation of treatment options available for this seriously understood mental illness."

"New Labour" drug

Dr Matt Muijen, director of the Sainsbury's Centre for Mental Health, agreed that Prozac was a "good, modern" anti-depressant.

However he said: "It is very much a new Labour drug: good marketing and good PR."

"It is a good anti-depressant - like many other good, effective anti-depressants that are also available."

Dr Muijen, a psychiatrist who carried out one of the first trials of Prozac in the UK, said he took exception to some of the more extravagant claims made for the drug. Some people have claimed that it can transform the personality.

"I thought it was rather over-hyped," he said.

Patient's experience

Alison Faulkener, manager of the Strategies for Living project run by the Mental Health Foundation, said that patients had reported mixed feelings about using Prozac.

Ms Faulkener took the drug herself, and found that it did little to improve her symptoms.

"For the first couple of months it did lift my depression," she said.

"But subsequently I suffered from increased anxiety and from physical shaking and became very panicky. After about four months I had to change to another medication."

In contrast, Ms Faulkener said she had interviewed patients who had found taking Prozac to be a very positive experience.

"My overall feeling is that people need much more than just a drug to treat depression," she said.

"They need the opportunity to talk about the problems they are experiencing.

"Whenever a new drug comes onto the market there is a risk that it is portrayed as a cure-all, a wonder drug. People need to be more cautious."