The Case for Antidepressants

Abigail Zuger in The New York Times:

BookIn a telling passage toward the end of his latest celebration of antidepressant drugs, Dr. Peter Kramer looks back on the pleasures of his long psychiatric career. He mentions the good company of his patients, his teachers, his colleagues. Then he turns to his favorite medications. He seems to choke up a little. “To get to meet Prozac and then to work in concert,” he writes without a trace of irony. “I am conscious of the privilege.” One needs no better evidence that the relationship between prescribers and their pills is quasi human, a partnership that may be utterly rational or wildly emotional, bolstered by wishful thinking, undone by bitter suspicion. Such has certainly been the case for antidepressants. Their safety and efficacy have been questioned repeatedly over the last decade. Some patients maintain the drugs are poison, while some experts have suggested they are just pricey, overused placebos. Foremost among the drugs’ champions has been Dr. Kramer, the author of “Listening to Prozac” in 1993 and a professor at Brown Medical School, who now offers a long, point-by-point defense composed of anecdotes and data.

Dr. Kramer’s bottom line is well summarized by the double meaning of “Ordinarily Well: The Case for Antidepressants” — he argues that antidepressants work just about as well as any other pills commonly used for ailing people, and that the drugs keep people who take them reasonably healthy. Antidepressants are not magic, Dr. Kramer acknowledges; they come with a risk of side effects, and their use in children can be quite problematic. But he has found them immensely helpful in the care of pretty much every variety of depressed adult. Further, he can back up his impressions with statistical proof. The reader with no particular ax to grind will emerge from the book with two impressions. One is that Dr. Kramer’s data is extremely persuasive. A second is that future rebuttals may well be just as persuasive, thanks to the staggering difficulties of subjecting psychoactive agents to rigorous scientific analysis. For its articulate, heartfelt demonstration of all those problems, the book is invaluable.

More here.