In addition to the effects of alleviating depression and other conditions classified as psychiatric disorders, there have been reports of fluoxetine performing beyond the relief of symptoms of these disorders (Fieve, 1994). These reports are what transformed the media image of fluoxetine from a new type of anti-depressant into a designer drug with spectacular effects (Breggin, 1994).
What are the alterations in personality reported with fluoxetine use? Kramer describes a general improvement in mood, with patients reporting feeling "better than well," (1993, p. x). Under the influence of fluoxetine, people become more optimistic, decisive and flexible. Effective in relieving unnecessary anxiety, guilt and shame, fluoxetine is believed to allow people to experience previously inhibited pleasure (Kramer, 1993). Socially, fluoxetine is reported to make people feel more secure, give them a more outgoing personality and a dramatically different social life (Kramer, 1993).
A contrast to this favorable evaluation is Breggin's (1994) report that fluoxetine causes agitation, irritability, excitement, impatience and belligerence. Breggin (1994) believes that people become arrogant, restlessly outgoing, and exhibit grandiose behaviors. He also cites the example that people on other drugs such as alcohol and amphetamines believe that they are better off when in fact their condition has become worse.
A resolution may be made by the classification of these characteristics into states on a continuum of behavior. Hyperthemia is a state slightly above the "normal" temperament. It is characterized by an energetic, confident and active attitude, with some irritability. Besides irritability, these traits are highly admired in western culture (Fieve, 1994). Hyperthemic people have the ability to successfully balance a multitude of projects and relationships.
Hypomania is the temperament a step beyond hyperthemia. People described as hypomanic are overactive socially, physically and sexually. They may be charming, explosive, irritable and angry. In a hypomanic state, people seem tireless in energy and may periodically overestimate their abilities (Breggin, 1991). The state of Mania is (especially manic psychosis) at the extreme end of the scale. Manic episodes are periods of hyperactivity, intense productivity and denial of problems with an accompanying mood of euphoric joy and well-being out of all proportion to the actual events in a person's life (Comer, 1992).
As the states of temperament rise above "normal," a person's mood is elevated, energy and expectations are increased, and the person becomes evermore withdrawn from reality (Breggin, 1991). A person's mood may thus be placed on a scale of increasing elation and irritability. The reaction of a person to fluoxetine may be measured by this scale. Fieve (1994) has produced estimates of a graduated response. Thirty to thirty five percent of patients are unresponsive to fluoxetine. Half of all people taking fluoxetine report relief of depression and return to normal self. Less that one tenth of patients undergo a "transformation of character" that results in a character perceived as "better than well." About one percent of fluoxetine users develop a manic reaction (Fieve, 1994). It may be under this state that the reported adverse reactions to fluoxetine such as violence, suicide and psychosis occur (Breggin, 1994).
How does someone gain the personality that they have? The interaction of genetics and environment comes into play. Some characteristics may be inherited from a parent, others the result of events that happened in that person's life. Some will divide personality into temperament, considered to be the genetic component, and character, which is acquired through environmental experience (Fieve, 1994).
One factor that can be certain is that the development of character takes time. The person's whole life may contribute toward their behavior. How does this personality exist? It may seen amazing that someone's whole character is contained in their brain. The interactions of neurotransmitters at the synapses are the root of brain functioning (Changeux, 1985). It follows that these chemical messengers may have a great effect on the way a person's behavior is expressed.
Considering the large investment of experiences and time that shapes a personality, it is surprising when a drastic change occurs in a relatively short amount of time. In some cases it appears that fluoxetine does just this (Kramer, 1993). The effect of anti-depressants is remarkable in the first place. A person's mood may be ameliorated from an emotionally-crippling clinical depression. Anti-depressants may also reduce obsessions and compulsions, and relieve phobias. In one month, a person's whole outlook on life may be changed. Taking someone with a set of moods and experiences and giving them a different temperament seems like quite an accomplishment. What makes that person change? Can all this be reduced to the level of a neurotransmitter in the brain? Since these neurotransmitters have been shown to have an effect on character, personality probably has some relation to them. If something as drastic as a person's level of aggression is impacted by serotonin, other behaviors and other neurotransmitter may be related well.