A book that does exactly what it says on the tin, this accessible history of antidepressants combines clinical anecdotes with analysis of research findings to make a case for the ongoing use of antidepressants. Each chapter opens with a new development in the use of antidepressants with a matched patient anecdote. The narrative journey follows both the author’s own transition from sceptic to prescriber, and the development of antidepressant prescribing practice. The controversies surrounding antidepressants and suicidal ideation as well as efficacy concerns are explored in depth suitable to the wide target audience, but the author has staked his ground from the outset and it is clear that the emphasis is on the benefit of antidepressant use.
Those who have read Dr Kramer’s previous book Listening to Prozac (1993) may be interested to read about the fallout from that book and Dr Kramer’s experiences since that time, detailed in the introduction. Following that book he became a controversial figurehead for psychiatry and a reluctant target for those who opposed the use of antidepressants. The writing style is similar to that book – lighter than an academic text and somewhat autobiographical, and he remains a self-deprecating, even at times, charmingly insecure narrator.
The book’s central thesis is that antidepressants truly work ordinarily well, that is, better than placebo. It begins with a grim depiction of the experience of those with depression before the development of antidepressant medications, and an emphasis on the seriousness of the illness and the necessity of adequate treatment, is sharply maintained throughout the book. The focus on depression as a serious illness sets up the central idea that in order to be acceptable, antidepressants need only work ordinarily well against illness.
Subsequent chapters focus on individual agents or clinical problems like recurrence, making each chapter an easy stand-alone quick read as well as part of a developing story. Breaking down the design and reporting of studies like STAR*D, combined with some unreported research findings, Dr Kramer sets out the case for antidepressants. The policy and prescribing developments discussed are centred on practice in the United States, but the clinical scenarios are more generally relevant. Dr Kramer presents his own views on matters such as prescribing medication for mild depression (a ‘do’) and continuing antidepressants for all post-recovery (a ‘don’t’), with reference to a variety of research, but the tone of his advice is more conversational than sermonising. One criticism of the book is that it arguably does not lend sufficient weight to the concerns expressed by those who read media coverage of studies reporting links between antidepressants and suicidal ideation.
Some of the reflective anecdotes don’t reflect Irish prescribing practice and may seem sentimental to a clinician reader, but most are vivid descriptions and provoke some reflection on one’s own prescribing practice. The concise history of antidepressant discovery is well drawn, with new light cast on some key names that will be familiar to psychiatry trainees, such as Roland Kuhn.
Some readers may find the layperson explanations of research terms tedious, but the short chapters (some only a page) and light tone make for easy reading. The notes, index and glossary are well composed and adequately detailed for a non-academic text, but research is not referenced throughout the book.
For trainees, there is a lot to glean from the book. The research discussions help put into context some statistical terms and methods required for exams and journal clubs, as well as nearly a lifetime of prescriber decisions and experience detailed in the clinical sections. It’s likely that doctors in psychiatry will like this book, which is for us, a catalogue of successes involving the treatments we regularly employ. It would be interesting to hear the views of non-biological mental health professionals or those with differing experience of medication use. The book lives up to its title and presents a convincing, as well as entertaining, case for antidepressant use.
Conflict of Interest
None.
