ORDINARILY WELL

The 1993 publication of Kramer’s Listening to Prozac set off a controversy about the use of mind-altering drugs in the treatment of mental illness that has still to be resolved, a situation the author finds deplorable.

Now, almost a quarter century later, Kramer (Brown Medical School; Freud: Inventor of the Modern Mind, 2006, etc.) explains that he had not intended to debunk the value of antidepressants in the treatment of depression. His book not only became a bestseller, turning him into a minor celebrity, but its catchy title was used in broadsided attacks on antidepressants with which he did not agree—e.g., a 1998 article called “Listening to Prozac but Hearing Placebo.” The author’s concern had been the possibility that the drugs’ mind-altering side effects might be used “to tweak” personality—though he admits to having enjoyed the celebrity status that came with the book’s publication. In his own psychiatric practice, Kramer finds that psychotherapy and antidepressants both have important roles to play in combating depression. The interplay between them is the subject of an ongoing discussion between himself and his patients as they jointly evaluate the success of treatment. “This book is about two influences on medical practice,” he writes, “rigorous trials and clinical encounters.” Kramer worries that overemphasis on rigorous trials and statistical analysis of outcomes is eroding the doctor-patient relationship, not allowing for a more flexible, case-by-case approach to treatment. “A tiny fraction of what doctors do finds direct representation in research,” he writes. While the efficacy of antidepressants combined with psychotherapy is well-established, how long to maintain their use following recovery is still under debate. It is a question of achieving a balance between preventing the recurrence of depression and side effects such as the occurrence of cataracts and lowered calcium absorption.

Written with the compassion, verve, and style that are the author's trademark, this book offers an invaluable overview on the state of treatment and the options available.