That 'Prozac' Man Defends the Gravity of a Disease (book review)

[HuckleB]

That 'Prozac' Man Defends the Gravity of a Disease

http://www.nytimes.com/2005/05/09/books/09masl.html

"In his new book, Peter D. Kramer tells a story about traveling to promote the best-known of his earlier books, "Listening to Prozac," and regularly encountering the same kind of wiseguy in lecture audiences. Wherever he went, somebody would ask him whether the world would be shorter on Impressionist masterpieces if Prozac had been prescribed for Vincent van Gogh.

Sunflowers and starry nights aside, this anecdote is revealing. It conveys both the facts that "Listening to Prozac" made a mental health celebrity out of Dr. Kramer (who is a clinical professor of psychiatry at Brown University) and that the book's success left him uneasy. He became a target, not only of New Yorker cartoons (one of which featured a Prozac-enhanced Edgar Allan Poe being nice to a raven) but of condescension from his professional peers. He found out that there was no intellectual advantage to be gained from pointing the way to sunnier moods.

"Against Depression" is a defensive maneuver against such vulnerability. With both a title and an argument that summon Susan Sontag (in "Against Interpretation" and "Illness as Metaphor"), the author argues against the idea that depression connotes romance or creativity. While fully acknowledging depression's seductiveness (Marlene Dietrich is one of his prototypes of glamorous apathy), and grasping how readily the connection between gloom and spiritual depth has been made, Dr. Kramer argues for a change in priorities. He maintains that depression's physiology and pathology matter more than its cachet.

Dr. Kramer makes this same point over and over in "Against Depression." It may be self-evident, but it's not an idea that easily sinks in. As this book points out, the tacit glorification of depression inspires entire art forms: "romantic poetry, religious memoir, inspirational tracts, the novel of youthful self-development, grand opera, the blues." There isn't much comparable magnetism in the realms of resilience, happiness and hope.

..."

[HuckleB]

1. Inquiring minds

Psychiatrist Peter Kramer isn't happy with how depression is perceived in society, and he's doing many things about it

http://www.boston.com/ae/books/articles/2005/05/09/inquiring_minds/

"He does not look like one who would lead a cavalry charge. Seated in a wing chair in his Federal-style home on College Hill, with its elegant furnishings and muted colors, Peter D. Kramer, 56, is the very image of a mild-mannered psychiatrist.

He is leading a charge, however, not on horseback but armed with his new book, "Against Depression." His adversary is the sentimental and romantic defense of depression, and society's failure to face what he sees as an obvious fact -- that depression is a disease, with no redeeming qualities, like diabetes or cancer. It is, he writes, "the most devastating disease known to mankind," with an estimated "workplace cost" in America of more than $40 billion.

Kramer, professor of psychiatry at Brown University, distinguishes depression from transitory moodiness. True depression usually includes symptoms such as sleeplessness, eating problems, intractable sadness and feelings of worthlessness, paralysis of the will, and often suicidality. Almost everyone experiences sadness, self-doubt, or melancholy sometimes, but the nondepressed person has what Kramer calls ''resilience" -- he or she can get back on an even keel without damage.

Kramer's 1993 bestseller, ''Listening to Prozac," explored the ethical questions surrounding a drug that many of his patients said made them feel ''better than well," like different people. Should society give, or withhold, drugs that seem to change their personalities? The book did not toss out psychotherapy or anoint Prozac as a magic bullet for depression, but some reviewers took it that way.

..."

[Pizza]

2. I prefer wellbuterin

[imenja]

6. Wellbutrin works on dopamine and norepenepherin

not on seratonin. It is often best used in combination with an SSRI.

[Celebration]

3. May have been listening to a placebo

http://www.journals.apa.org/prevention/volume1/pre0010002a.html

"ABSTRACT
Mean effect sizes for changes in depression were calculated for 2,318 patients who had been randomly assigned to either antidepressant medication or placebo in 19 double-blind clinical trials. As a proportion of the drug response, the placebo response was constant across different types of medication (75%), and the correlation between placebo effect and drug effect was .90. These data indicate that virtually all of the variation in drug effect size was due to the placebo characteristics of the studies. The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect. Examination of pre–post effect sizes among depressed individuals assigned to no-treatment or wait-list control groups suggest that approximately one quarter of the drug response is due to the administration of an active medication, one half is a placebo effect, and the remaining quarter is due to other nonspecific factors.



EDITORS' NOTE
The article that follows is a controversial one. It reaches a controversial conclusion—that much of the therapeutic benefit of antidepressant medications actually derives from placebo responding. The article reaches this conclusion by utilizing a controversial statistical approach—meta-analysis. And it employs meta-analysis controversially—by meta-analyzing studies that are very heterogeneous in subject selection criteria, treatments employed, and statistical methods used. Nonetheless, we have chosen to publish the article. We have done so because a number of the colleagues who originally reviewed the manuscript believed it had considerable merit, even while they recognized the clearly contentious conclusions it reached and the clearly arguable statistical methods it employed."

[HuckleB]

4. One argument among many.

There is little doubt that placebo often plays a part in the role of antidepressants. Interestingly, many psychiatrists have found that those who report immediate positive effects find that the antidepressant often "stops working" fairly quickly, while those who don't note any positive effects for four to eight weeks (which would be expected) typically see benefits that last much longer. So, it seems that it might be possible to note placebo vs. true benefit, at least in some cases.

[imenja]

7. Depression suffers will take exception with that

Listening to Prozac gives a view of anti-depressants that, I think, is not entirely common. I don't think the drugs remake most people's personalities in the way Kramer described. But anti-depressants, although not nearly effective enough, are certainly better than a placebo--even if most studies show them performing only somewhat better, not dramatically better and not the same, as placebos. Hopefully more effective medications will be developed soon.

[HuckleB]

5. There's Nothing Deep About Depression

http://www.concernedcounseling.com/Communities/Depression/news_2005/antidepressants_1.asp