By Peter D. Kramer, MD
Farrar, Straus and Giroux, 2016, $27
“Denying the efficacy of antidepressants may begin well enough, with a love of psychotherapy and a respect for human complexity. But in time, the position becomes stigmatizing, too much in accord with the notion that depression is something other, something less than what research and practice find it to be: a progressive, destructive multisystem disorder fully worthy of medical attention.” —from Ordinarily Well
Kramer, a clinical professor emeritus of psychiatry and human behavior at Alpert Medical School, first waded into the psychopharmacology debate in 1993 with his book Listening to Prozac. Now, armed with two more decades of clinical experience, as well as scientific data and analysis, he takes on the latest charge, that antidepressants are no better than placebos.
Ordinarily Well offers a mostly chronological account of the history of the drugs and their development, interspersed with moving anecdotes of his patients and his own, evolving practice. Kramer acknowledges the “mixed blessing” of antidepressants’ success—discussing cons like overprescribing and industry influence on medical practice and academic research—and explains the shortcomings of conventional drug trials, which he says don’t reflect real-world patient encounters. Clinical experience, personal judgment, and “common sense,” he argues, have a place in psychiatric treatment, alongside the statistics. “Could a doctor rely on randomized trials only and treat real people?” he asks. “What would that practice look like?” For Kramer, to rely on evidence-based medicine alone is to reduce his patients to mere data points, and to distrust his own eyes and ears. “[C]onsider what patients say,” he writes: “On medication, they have come back to life.”
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