BOOK DOCTOR: ANTIDEPRESSANTS ARE EFFECTIVE

In 1993, Peter D. Kramer wrote Listening to Prozac, a book that explored the ethics of prescribing what was then a relatively new class of antidepressants that, quite separate from treating depression, made patients more confident, outgoing and energetic — in short, “better than well.” The book was a bestseller, Kramer became a public figure and the medication, selective serotonin reuptake inhibitors, was widely prescribed. But the phenomenal success of the drugs, and a cultural bias in favour of psychotherapy — a sense that self- understanding is better than popping a pill — led to a backlash against psychopharmacology and a spate of articles questioning their effectiveness. Was it possible the reprieve that patients reported was due to the placebo effect? Now, after pursuing other interests, Kramer has rejoined the debate with a new book, Ordinarily Well, that offers a carefully argued and convincing case that antidepressants not only work but also are an essential tool in the treatment of depression. The title is medical lingo, another way of saying the drugs are “as beneficial as most treatments that doctors are content to use.” Kramer begins by reviewing the development of pharmaceuticals to treat depression, from tricyclics and MAOIs in the 1950s to SSRIs in the ’ 80s, the category that includes Prozac, Zoloft and others. Throughout the book he weaves in stories from clinical practice about people whose lives markedly improved on the drugs. After laying out the pros and cons, he remains a believer. The deniers, he says, do not recognise the “scourge” of depression for what it is: “a progressive, destructive multisystem disorder fully worthy of medical attention.” —