Listening to Prozac: The Landmark Book About Antidepressants and the Remaking of the Self

In exploring the role of experience on mood, in chapter five Kramer turns to various observations on "rapid-cycling." Certain people have been observed to swing back and forth between dark depression and wild euphoria in a matter of hours, seemingly with very small (or no) external provocations (pp.108-109).Kramer applies three models, which he sees are interconnecting, to this issue. First, Kramer summarizes the finding of Robert Post and his "kindling model." Post's work concluded that rapid-cycling was often the end stage of a long-term recurring problem. "The general pattern was a decrease in the interval between episodes and an increase in the severity and complexity of the episodes, until finally rapid cycling set in" (p.109). As time passes, Post's studies seem to indicate, ever smaller stimuli are needed to provoke ever severe episodes. While many biological processes operate in the opposite way, requiring ever greater amounts of stimulus (street drugs, etc.), others (epilepsy; bipolar conditions, etc.) are "kindled." Interestingly, two seemingly unrelated conditions that are "kindled" seemed to respond positively to the same medications (pp. 112f.).The second model Kramer discusses here is that suggested by stress research in rats (pp.116-118). The rat studies "impl(y) that a variety of psychosocial stressors can serve as triggers" for the biologically encoded factors "kindled" in depression (p. 122).The third model examined in chapter five is the monkey-separation studies (pp.118-122). Rhesus monkeys seem especially helpful in reflecting on human problems due to similarities between the species (p.118). Kramer concludes from these studies that in the early stages of stress-induced kindling subjects will appear very normal, except that they will have a somewhat heightened sensitivity to loss (p. 122).Kramer concludes that pain brings scars, even when it does not seem to immediately result in depression (p. 123). He explains, "What distinguishes this view of depression from, say, traditional psychoanalytic models is the recognition that the scars are not, or not only, in cognitive memory. It is not merely a question of inner conflict or of `growing up': `Stop fussing over what your parents did to you!' as skeptics command patients in therapy. The scar consists of changed anatomy and chemistry within the brain (emphasis added)" (p. 123). Kramer notes the implications of his neurobiological conclusions: "It seems that the neural pathways are like the joints in the musculoskeletal system. They are worn down over the years by inevitable trauma... Age alone seems a trauma... if we live long enough we will all become depressed" (p. 135).The point of this is that Kramer believes that Prozac can have a key role in the treatment of relatively `minor depressive illness' (p. 126). If diagnosed early enough, Prozac and SSRIs "can help prevent the progression of early mood disorder into florid illness" (p. 127).I found the thoughtful commentary of this chapter five fascinating and not a little alarming. Could Kramer be correct that neural pathways significantly impact mood and that they may have been irreversibly worn down through stress, leaving one more susceptible to depression now?I do not know what to conclude about this. There are many who dispute this view of neurobiology. But even if Kramer is partly correct in these conclusions, the Bible offers a far richer potential interpretation of this information than Kramer's naturalistic worldview. As Ed Welch points out in Blame it on the Brain (1998), the the body is the mediator of moral action, not the initiator. It is the `equipment of the heart' (p. 40). Bad thoughts and actions, in response to the temptations presented by stressful circumstances, can impact the body. Perhaps my failures to deal with trauma help cause the depression I suffer, and this depression may have permanent physiological effects. The returning feelings of depression that I now wrestle with may be, as Welch contends, `body' rather than `heart' problems (Welch, p. 45), but my response to those feelings is still a spiritual issue not a brain issue. Prozac, or any other treatment that seeks to address the brain alone, can not hope to get at the critical heart issues involved in depression.

Prior to reading Kramer's now-classic ruminations on Prozac and its sibling drugs, I read Joseph Glenmullen's Prozac Backlash, a damning response to Kramer's work. Glenmullen is convincing and well documented (and speaks to my own prejudices); therefore, I was prepared to despise Kramer. I didn't. And I don't. Granted, Kramer does not spend much time on the undesirable side effects of Prozac and other antidepressant drugs, but it's almost beside the point, since his emphasis tends towards philosophical and ethical efficacy, rather than medical efficacy. Kramer does not pretend to be doing anything other than laying bare some very challenging questions. He prescribed Prozac as an antidepressant and discovered that it was altering personalities--not in the far more negative way that was later found in cases of uncharacteristic violence, but in ways that patients perceived as positive. Formerly shy people were far more outgoing. Kramer raises an important question: Is it ethical to withhold a treatment for painful shyness when the physician has no reason to diagnose depression? Dozens of (to me) frightening facts are reported; for instance, for the past fifty years it has been commonplace to make a diagnosis after observing drug side effects. In other words, now that we know that Prozac can cure shyness in some people, shyness is now a diagnosis that needs a cure. Particularly interesting and insightful is Kramer's observation that certain personality characteristics are valued (or de-valued) in various cultural scenarios, which change over time as well as from one group to another. Speaking of his client who overcame shyness as a side effect of her anti-depressant medication, he writes, "If we see Tess's transformation as a victory, it's because of a change in mores, because we value the assertive woman and shake our heads over the long-suffering self-sacrificer. Perhaps medication now risks playing a role that psychotherapy was accused of playing in the past: it allows a person to achieve happiness through conformity to contemporary norms." Kramer also cited a quite intriguing series of monkey studies, where researchers found that the Alpha male (tribal leader) had higher levels of serotonin than other males in the tribe. Also, when an Alpha male was defeated in a challenge to his leadership, his serotonin levels took an immediate dive. The researchers arbitrarily gave serotonin to male monkeys to see if it influenced the balance of power in the tribe. They found that, if the Alpha male had been removed, the serotonin-enhanced monkey quickly became the new leader. However, in the presence of a reigning Alpha male, the serotonin-enhanced monkey was unable to rise further than first lieutenant. Citing study after study of various components of brain chemistry, Kramer brings me to question the whole notion of personality as being an integral characteristic of the individual human being. More and more I become confused about how much of me is me and how much is a chemical soup that controls my emotions and behaviors. Glenmullen's book is the most constructive, in terms of revealing effective treatments for depression, yet I still recommend Kramer for his thoughtful evaluation of the possibilities represented by these drugs and his unabashed admission of the philosophical issues and ethical questions involved.

The author does a very fascinating exploration on the meaning of the self and what is considered acceptable use of tools such as antidepressants and sometimes psychotherapy.

The downloaded text was rotated 90 degrees, and I could not adjust the font size. I notice other readers complained about missing footnotes, & Amazon claims that they have fixed this. I was unable to get far enough in the book to find out. SO, IF YOU ARE A KINDLE READER: BEWARE!!

As someone who's been on Paxil for over a year, I've had many a conversation (with friends and with my therapist) about what it is, precisely, that Paxil (and it's buddies in the Prozac family) does. And should it be doing it? At what point is depression an "illness" that warrants medicated treatment and when is it simply a "normal" amount of bad feelings? Is Paxil a crutch? And if it is, does that mean that it shouldn't be used?This book addresses these questions intelligently and honestly. One of the things I admire about the book is that it doesn't pretend to have answers. It suggests possibilities, yes, and the author will frequently offer his own opinions, but he's very upfront about his own discomfort with the "Miracle Cures" that Prozac, Paxil, etc. have brought about, and the questions these cures raise for the usefulness of therapy.If you know anyone who's on any of these drugs or if you yourself are on them, I cannot recommend this book highly enough. Whatever your own opinion may be, I think you'll find this book offers a lot to think about.

Decent book about prozac. I'd recommend it for anyone who is prescribed prozac.

I like this book as it is informative for anyone who takes prosac as it's written by a person who has a lot of experience with clients who have taken prosac for a long time.

Buch kam sehr spät & beschädigt an!

Amazing book, great insight into what we know and what we don't know about mental disorders. Gives global picture but also very often more unique and individual perspective that helps to connect with our own experience. I wish I could have read it sooner.