Antidepressants Do Work “Ordinarily Well”

In “Ordinarily Well,” Dr. Kramer, who has written so well about the curse of melancholia — that thief who steals your blood and slyly replaces it with lead — has done something very valuable: He has waded into the contentious debate about the efficacy of antidepressants. It’s an important and confusing subject. One in eight Americans rely on these medications, hardly a trivial number. Jennifer Senior, New York Times, on the idea that antidepressants do work

Ordinarily Well: The Case for Antidepressants by psychiatrist Peter Kramer, who has sometimes been dubbed “Dr. Prozac” by the media, returns to a subject he famously visited before in Listening to Prozac (1993). Antidepressants do work, Kramer claims in this newest book, opposing the views of some other experts in the field.

Why Kramer Wrote Ordinarily Well

Publishers Weekly cites one incentive for this book: “…Kramer’s more captivating story is about the resistance to antidepressants that emerged in the 1970s and was further stoked by Irving Kirsch’s 1998 essay, “Listening to Prozac but Hearing Placebo,” which took direct aim at Kramer’s work.”

Miller offers another:

The book is written as a response to the ‘research’– now seen so often in headlines – that antidepressants are as effective as sugar pills for mild to moderate depression, and they should be prescribed only for severe major depression. He gets even more specific: The book is written partly in response to an article by Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine, published in June 2011 in the New York Review of Books, and Dr. Angell’s assertion that psychiatric medications are no more effective than placebo. Since psychotropics come with more side effects than placebos, the next logical conclusion is that they are not only ineffective – they are harmful.

Kramer’s Main Conclusions

Kramer’s conclusion, states Miller, is that “(m)ost patients with depression, be it mild, moderate, severe, or long-standing dysthymia, have a good response to antidepressants. It’s the minority who don’t respond.” Antidepressants do work, in other words.

‘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.

Thomas R. Insel, MD: “Antidepressants work, keeping depression at bay. For some they are not sufficient. And for an unfortunate few, they are not effective. But remembering the hopeless state of treatment only a few decades ago, Kramer reminds us with compelling prose and compassionate insight that today millions of us are much better off with access to these medications.”

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