Peter Kramer: ‘In Defense of Antidepressants’

Dr. Peter D. Kramer

As we’ve noted here and here, The New York Review of Books just ran a two-part essay by Dr. Marcia Angell, former editor of The New England Journal of Medicine, on the ills of modern American psychiatry, with its heavy reliance on sometimes dubious drugs.

 

Now comes a response, a piece by Dr. Peter Kramer, of “Listening to Prozac” fame, that dominated the front of the SundayReview section in The New York Times. Peter opens with the recent bad press that antidepressants have been getting, including in Marcia’s writing, then asks:

Could this be true? Could drugs that are ingested by one in 10 Americans each year, drugs that have changed the way that mental illness is treated, really be a hoax, a mistake or a concept gone wrong?

This supposition is worrisome. Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment.

Peter walks the reader through a broad swath of recent research on antidepressants, and writes:

Better-designed research may tell us whether there is a point on the continuum of mood disorder where antidepressants cease to work. If I had to put down my marker now — and effectively, as a practitioner, I do — I’d bet that “stuckness” applies all along the line, that when mildly depressed patients respond to medication, more often than not we’re seeing true drug effects. Still, my approach with mild depression is to begin treatments with psychotherapy. I aim to use drugs sparingly. They have side effects, some of them serious. Antidepressants help with strokes, but surveys also show them to predispose to stroke. But if psychotherapy leads to only slow progress, I will recommend adding medicines. With a higher frequency and stronger potency than what we see in the literature, they seem to help.

My own beliefs aside, it is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not. To give the impression that they are is to cause needless suffering.

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  • Carrie

    Oh they are not placebo, they are dangerous drugs that suppress emotions.  When the dam breaks and the emotions flood forth, the user is a danger to him/herself and others.  It is a crying shame that profit is put before people.

  • Altostrata

    Robert Whitaker soundly refutes Peter Kramer on his Psychology Today blog http://www.psychologytoday.com/blog/mad-in-america/201107/the-new-york-times-defense-antidepressants-0 Seems as though Dr. Kramer misrepresented key studies in his NYTimes article.

    Having authored Listening to Prozac, Dr. Kramer has a vested interest in the success of the antidepressant revolution he helped set in motion. He is anything but objective, and the subjective nature of his NY Times piece shows this. If anyone is going to have cognitive dissonance about the fantasy and the reality of antidepressants, it’s going to be Peter Kramer. He is on the wrong side of history. Perhaps this clouded his interpretation of Irving Kirsch (“The Emperor’s New Drugs”) and Robert DeRubeis’s work.

    It’s too bad so many reviewers have taken Dr. Kramer’s NYTimes piece at face value, trusting his version of the research, and reported it as even semi-factual.

  • Amltopsfield

    an old friend used to say that people who are mildly depressed should try the following before taking medications, “Get a job, exercise, and get a pet.”  If these don’t work, then maybe it’s time for some therapy and medication.   From the posts I’ve read here about the mood benefits of exercise and pets, I’d say he was on to something.