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Jill S. is 34. She holds a degree in art history, lives in a 4,000-square-foot house in west Little Rock, and considers herself lucky to be able to stay home with her three children until they're old enough for school.
So why is Jill depressed?
She doesn't know, and neither does her doctor. What both of them do know is that by swallowing a tiny beige-and-green pill in the morning, Jill can "take the edge off" the rest of her day. She no longer feels tired, the relentless "blue fugue" that gripped her is lifted, and after months of what she looks back on as "monsterhood," she enjoys being around her children again.
The pill Jill takes is Prozac, the most widely prescribed antidepressant in history. If you're not a user yourself, you almost certainly know people who are and for whom the drug has proven almost a miracle.
Since its introduction in 1987, Prozac has become as much a staple in Arkansas medicine cabinets as it has everywhere else in the country. Nationally, doctors write more than a million prescriptions for it a month.
The irony is that many if not most of the pill's users are people like Jill; educated and financially comfortable.
"I couldn't prove it, so don't use my name," a psychiatric nurse in Little Rock said, "but I'd bet if you could lay a map of Prozac use over a map of Arkansas, you'd find the densest concentration in Pulaski County, and the densest there in west Little Rock."
If such a pattern exists, one reason for it might be that the pills are expensive, costing up to $2 apiece, or about $700 a year. Another possible explanation is that the affluent, in general, have better access to health care.
But depression is no respecter of status. Doctors at the Veterans Administration
Medical Center in North Little Rock, say more than 40 percent of the 3,750 patients treated there each month suffer from depression and that many use Prozac to alleviate it.
Use at private psychiatric facilities is also heavy. Dr. Richard Owings, medical director at Charter Hospital in Maumelle, estimates that about half the patients at that hospital come because of depression, and that in addition to other therapy, most of them end up with a prescription for Prozac.
Owings points out that many patients only take the drug for six months or so, to alleviate a temporary depression.
But he also adds, "there are people who cannot have a good mood without it."
Users are quick to point out that Prozac doesn't provide a recreational "high," like Valium and other psychoactive drugs that are subject to abuse. In fact, the effects can be unpleasant for people who are not seriously depressed.
But for those who do benefit from Prozac, the results can be dramatic. Some users have described it as a firm but gentle lift out of despair.
Elizabeth Wurtzel, a New York Writer who was headed to a mental institution after years of depression and finally a suicide attempt, was finally given Prozac, which at the time had only recently been introduced.
"This may sound ridiculously simplistic," she later wrote, "but within a couple of weeks after I fist began taking the drug daily, I woke up one morning and felt fine. And I've been fine ever since."
Thousands of Arkansans have experienced similar relief. "Depression, notes Dr. Don E. McMillan, chief of pharmacology at the University of Arkansas for Medical Sciences, "is a very common problem." No one
understands exactly why that is, though most psychiatrists agree that the factors are often complex and can include changes in body chemistry, personal loss, an unhealthy lifestyle, or simply, as Owings put it, "something inherent in the human condition."
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