The Antidepressant Era

In this work Healy chronicles the history of psychopharmacology, from the discovery of chlorpromazine in 1951, to current battles over whether powerful chemical compounds should replace psychotherapy. The marketing of antidepressants is included.

A psychiatrist provides an insider account on the controversial use of selective serotonin reuptake inhibitors (SSRIs) Prozac. Paxil. Zoloft. Turn on your television and you are likely to see a commercial for one of the many selective serotonin reuptake inhibitors (SSRIs) on the market. We hear a lot about them, but do we really understand how these drugs work and what risks are involved for anyone who uses them? Let Them Eat Prozac explores the history of SSRIs—from their early development to their latest marketing campaigns—and the controversies that surround them. Initially, they seemed like wonder drugs for those with mild to moderate depression. When Prozac was released in the late 1980s, David Healy was among the psychiatrists who prescribed it. But he soon observed that some of these patients became agitated and even attempted suicide. Could the new wonder drug actually be making patients worse? Healy draws on his own research and expertise to demonstrate the potential hazards associated with these drugs. He intersperses case histories with insider accounts of the research leading to the development and approval of SSRIs as a treatment for depression. Let Them Eat Prozac clearly demonstrates that the problems go much deeper than a side-effect of a particular drug. The pharmaceutical industry would like us to believe that SSRIs can safely treat depression, anxiety, and a host of other mental problems. But, as Let Them Eat Prozac reveals, this “cure” may be worse than the disease.

Mad people's historical anthologies and republished writings -- Mad people's perspectives in institutional histories -- Mad people's historical biographies -- Mad people's activist histories -- Conclusion -- Notes -- Chapter 16: Dementia: confusion at the borderlands of aging and madness -- Dementia in the distant past -- Framing dementia as a brain disease in modern German psychiatry -- Framing dementia as a problem in the adjustment to aging in mid-century American psychodynamic psychiatry -- Framing dementia as dread disease and major public health crisis in an aging world -- Conclusion: the ongoing entanglement of dementia and aging -- Notes -- PART VI: Maladies, disorders, and treatments -- Chapter 17: Passions and moods -- Emotions in history -- Grand narratives and overarching themes -- Specific stories and critical contexts -- Conclusion and areas for further scholarship -- Notes -- Chapter 18: Psychosis -- Madness -- Psychosis is a special thing -- If "psychotic" means "psychosis-like," then what, pray tell, is psychosis like? -- Schizophrenia -- Notes -- Chapter 19: Somatic treatments -- Conclusion -- Notes -- Chapter 20: Psychotherapy in society: historical reflections -- Notes -- Chapter 21: The antidepressant era revisited: towards differentiation and patient-empowerment in diagnosis and treatment -- Psychopharmacology and historiography -- Towards a new chemistry of the mind -- Mother's little helpers -- Appetite for new chemical wonders for the mind -- Towards differentiation and patient empowerment in the era of genomics -- Notes -- Index

This searing indictment, David Healy’s most comprehensive and forceful argument against the pharmaceuticalization of medicine, tackles problems in health care that are leading to a growing number of deaths and disabilities. Healy, who was the first to draw attention to the now well-publicized suicide-inducing side effects of many anti-depressants, attributes our current state of affairs to three key factors: product rather than process patents on drugs, the classification of certain drugs as prescription-only, and industry-controlled drug trials. These developments have tied the survival of pharmaceutical companies to the development of blockbuster drugs, so that they must overhype benefits and deny real hazards. Healy further explains why these trends have basically ended the possibility of universal health care in the United States and elsewhere around the world. He concludes with suggestions for reform of our currently corrupted evidence-based medical system.

David Healy follows his widely praised study, The Antidepressant Era, with an even more ambitious and dramatic story: the discovery and development of antipsychotic medication. Healy argues that the discovery of chlorpromazine (more generally known as Thorazine) is as significant in the history of medicine as the discovery of penicillin, reminding readers of the worldwide prevalence of insanity within living memory. But Healy tells not of the triumph of science but of a stream of fruitful accidents, of technological discovery leading neuroscientific research, of fierce professional competition and the backlash of the antipsychiatry movement of the 1960s. A chemical treatment was developed for one purpose, and as long as some theoretical rationale could be found, doctors administered it to the insane patients in their care to see if it would help. Sometimes it did, dramatically. Why these treatments worked, Healy argues provocatively, was, and often still is, a mystery. Nonetheless, such discoveries made and unmade academic reputations and inspired intense politicking for the Nobel Prize. Once pharmaceutical companies recognized the commercial potential of antipsychotic medications, financial as well as clinical pressures drove the development of ever more aggressively marketed medications. With verve and immense learning, Healy tells a story with surprising implications in a book that will become the leading scholarly work on its compelling subject.

Do antidepressants work, or are they glorified dummy pills? How can we tell? In Ordinarily Well, the celebrated psychiatrist and author Peter D. Kramer examines the growing controversy about the popular medications. A practicing doctor who trained as a psychotherapist and worked with pioneers in psychopharmacology, Kramer combines moving accounts of his patients’ dilemmas with an eye-opening history of drug research to cast antidepressants in a new light. Kramer homes in on the moment of clinical decision making: Prescribe or not? What evidence should doctors bring to bear? Using the wide range of reference that readers have come to expect in his books, he traces and critiques the growth of skepticism toward antidepressants. He examines industry-sponsored research, highlighting its shortcomings. He unpacks the “inside baseball” of psychiatry—statistics—and shows how findings can be skewed toward desired conclusions. Kramer never loses sight of patients. He writes with empathy about his clinical encounters over decades as he weighed treatments, analyzed trial results, and observed medications’ influence on his patients’ symptoms, behavior, careers, families, and quality of life. He updates his prior writing about the nature of depression as a destructive illness and the effect of antidepressants on traits like low self-worth. Crucially, he shows how antidepressants act in practice: less often as miracle cures than as useful, and welcome, tools for helping troubled people achieve an underrated goal—becoming ordinarily well.