Ordinarily Well: The Case for Antidepressants

by Peter D. Kramer

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Author: Peter D. Kramer

Publisher: Farrar, Straus and Giroux

Paperback:
ISBN 10: 0374536961
ISBN 13: 978-0374536961

“A carefully argued and convincing case.” ―Ann Levin, Associated Press

Do antidepressants actually work, or are they just glorified dummy pills? How can we tell one way or the other?

In Ordinarily Well, the celebrated psychiatrist and author Peter D. Kramer addresses the growing mistrust of antidepressants among the medical establishment and the broader public by taking the long view. He charts the history of the drugs’ development and the research that tests their worth, from the Swiss psychiatrist Roland Kuhn’s pioneering midcentury discovery of imipramine’s antidepressant properties to recent controversial studies suggesting that medications like Prozac and Paxil may be no better than placebos in alleviating symptoms. He unpacks the complex “inside baseball” of psychiatry―statistics―and reveals the fascinating ways that clinical studies and their results can be combined, manipulated, and skewed toward a desired conclusion. All the while, Kramer never loses sight of the patients themselves. He writes with deep empathy about his own clinical encounters over the decades as he weighed treatments, analyzed trial results, and considered the idiosyncrasies each case presented. As Kramer sees it, we must respect human complexity and the value of psychotherapy without denying the truth―that depression is a serious and destructive illness that demands the most effective treatment available.

Review

A New York Times Book Review Editors' Choice

One of the Top 10 Health and Medicine Books of 2016, Booklist

"Dr. Kramer, who has written so well about the curse of melancholia . . . has done something very valuable: He has waded into the contentious debate about the efficacy of antidepressants . . . [Kramer] has done some much-needed synthesizing and debunking . . . his dissections of the most incendiary studies are careful, and his conclusions―that they overestimate placebo effects and underestimate the potency of antidepressants―will invite a reckoning of some kind . . . his 'interludes' describing his own experience treating patients . . . are beautiful, philosophical, ambivalent." ―Jennifer Senior, The New York Times

"Ordinarily Well is an ambitious, persuasive, and important book . . . [Kramer] doesn’t just make a case for antidepressants.He makes a case for psychiatry itself as a humanistic science . . . Kramer is an excellent guide as he subjects evidence-based purism . . . to the scrutiny he believes it needs . . . Kramer also works in a courteous fashion, respectful of his opponents and his readers, in whose patience and capacity for reason he places great faith." ―Jonathan Rosen, The Atlantic

"Careful and measured and fair . . . Kramer evinces such humility that no one could accuse him of being a promedication ideologue . . . Kramer is out to win the 'antidepressant wars' in favor of the antidepressants. Is he right? . . . in my judgment he is . . . You will most likely come away convinced by his argument for the efficacy of antidepressants―and moved by his humane concern for his patients, and for the needless suffering of unmedicated patients around the world." ―Scott Stossel, The New York Times Book Review

"Offers a carefully argued and convincing case that antidepressants not only work but also are an essential tool in the treatment of depression . . . Anybody who wants to hear what Prozac has to say will be interested in this book." ―Ann Levin, The Associated Press

"Kramer reaches into his own practice and into the scientific literature―amply documented here―to show that the charge of ineffectiveness is false. Antidepressants, he says, have given many patients back their lives, and some of these anecdotes are quite moving . . . [Kramer] comes across as modest and self-deprecatory, and giants such as Gerald Klerman, the onetime dean of American psychiatry, spring to life in these pages." ―Edward Shorter, The Washington Post

"[Ordinarily Well] seeks to restore public confidence in antidepressants through a combination of reporting, research analysis and [Kramer's] own experience with patients . . . it is certainly an important [read] for those who seek help for depression and the providers who treat them." ―Damon Tweedy, Chicago Tribune

"Peter D. Kramer provides a forceful rejoinder to this growing tide of skepticism [toward antidepressants]. Kramer has been a prominent voice on matters of mental health for some time . . . His new book takes a unique approach: though at times passionate and personal, it is mostly a detailed excavation of the thorny landscape of the empirical evidence for antidepressant medications." ―Adam Gaffney, The New Republic

"[Ordinarily Well] sheds new light on this controversial matter . . . After more than 20 years [since Listening To Prozac], Kramer wants to address properly what he thinks is a potentially dangerous level of ignorance and confusion about antidepressants . . . I enjoyed reading this book and I totally agree with the author when he argues that both clinical experience with real patients and randomised evidence from studies point in the same direction in a complementary way." ―Andrea Cipriani, The Lancet

"For its articulate, heartfelt demonstration of all those problems [surrounding antidepressants], the book is invaluable." ―Abigail Zuger, M.D., The New York Times

"Kramer is a fine writer with a gift for the evocative turn of phrase. His patients come alive on the page, and his account of the changes in psychiatry over the last forty years rings true . . . I recommend Ordinarily Well to everyone who prescribes antidepressants, and to psychotherapists, other health professionals, patients, and members of the public who may have doubts about their effectiveness." ―Burns Woodward, Psychiatric Times

"An engaging book about a complex topic, arguing throughout that antidepressants work well and have been given a bum rap . . . Despite the complexity of the topic and the breadth of his research reviews, Dr. Kramer tells the story of antidepressant research in a way that a lay reader can follow . . . The complexities are explained without medical lingo and, in the end, he concludes what psychiatrists see every day: Antidepressants work." ―Dinah Miller, Clinical Psychiatry News

"Kramer mounts a comprehensive, spirited, and completely convincing defense [of antidepressants], dispelling any doubts about their efficacy and life-changing capability . . . Kramer is at his best when he reflects on the privilege of being a psychiatrist, the value of a doctor’s steady judgement, and the vulnerability of physician and patient alike. He is unwavering: 'Placebos don’t prevent depression, and antidepressants do.' Case closed." ―Tony Miksanek, Booklist (starred review)

"I have always loved Peter Kramer's writing for the reflective way he weds his own practice and personal experiences with extant science to lead us to new and profound insights into the psyche. Listening to Prozac exemplified his ability to define a new paradigm. In Ordinarily Well, he brings a lifetime of treating patients to a consideration of antidepressants, looking carefully at the nature of evidence. The work of one of the few voices out there without ties to industry, this reasoned and beautifully written narrative is another breakthrough, one that brings us to a new and humane understanding of depression and its treatment." ―Abraham Verghese, author of Cutting For Stone

"In previous books, Peter Kramer has been an insightful clinician, a sensitive novelist, and a social critic. Here he is a thoughtful teacher. Using both the scientific literature and the lived experience of his own patients, he explains brilliantly the evidence supporting the use of antidepressants. As he notes, depression is a serious, life-threatening illness. Antidepressants work, keeping depression at bay. For some they are not sufficient. And for an unfortunate few, they are not effective. But remembering the hopeless state of treatment only a few decades ago, Kramer reminds us with compelling prose and compassionate insight that today millions of us are much better off with access to these medications." ―Thomas R. Insel, M.D, former director, National Institute of Mental Health

"Written with the compassion, verve, and style that are the author's trademark, this book offers an invaluable overview on the state of treatment and the options available." ―Kirkus Reviews

"Kramer makes an energetic and personal case for the role of antidepressants in easing crippling depression." ―Publishers Weekly

"Kramer has done it again. First, he showed the world the potentially transformative efficacy of antidepressants in Listening to Prozac. Now, in Ordinarily Well, Kramer dissects the controversy and misinformation about the effectiveness of antidepressants with impressive clarity and fairness. Kramer is a masterful teacher and clinician who gives readers a rare gift: an insider's understanding of this complex subject, including statistics and the design of clinical trials. Anyone who wants to know the truth about antidepressants should read this book." ―Richard A. Friedman, M.D., Professor of Clinical Psychiatry at Weill Cornell Medical College and contributing Op-Ed writer for The New York Times

"In this provocative and personal book, Kramer begins with the premise that he speaks in the voice of 'clinician as sinner.' For Kramer, the clinician's sin is to complicate the simpler story told by the randomized trials, the clerical voice in drug research. He makes the case that the studies need the narrative and the narratives need the studies. We have taken sides in a culture war in psychiatry that we can’t afford. Patients' well-being, indeed their very lives, depend on a declaration of peace. Ordinarily Well makes a compelling case for humility. Sometimes medications work but imperfectly or they work for a while but need to be changed. And sometimes they work when supplemented by the insight that only conversation can provide." ―Sherry Turkle, Professor of the Social Studies of Science, MIT, and author of Reclaiming Conversation: The Power of Talk in a Digital Age and Alone Together: Why We Expect More From Technology and Less from Each Other

"For anyone with depression or anyone who loves someone struggling with it, this book is essential. It's cutting edge psychiatry at its best―all the important questions, data, and controversy surrounding antidepressant treatment made crystal clear. Dr. Kramer is one of the rare experts who is, at once, analytically astute, vastly knowledgeable, clinically experienced, and personally very wise." ―Sally Satel, M.D., Yale University, and coauthor of Brainwashed: The Seductive Appeal of Mindless Neuroscience

"Biological psychiatry has shown that depression―poetically called 'malignant sadness'―is as biologically 'real' as cancer (or any other disease). This is most apparent when a drug changes the patient's neurochemistry and, with greater than chance frequency, the darkness lifts. Nonetheless, the value of antidepressants has been questioned in both scientific and pseudo-scientific circles. In Ordinarily Well, Peter Kramer, arguably the wisest clinician thinking and writing about depression, emphatically supports the efficacy of using antidepressants in the right place and time. Given the pandemic of malignant sadness that we face, this is a deeply important book." ―Robert Sapolsky, professor of biological sciences and of neurological sciences and neurology at Stanford University

"Ordinarily Well is vintage Peter D. Kramer: compassionate, thoughtful, provocative. This book makes a case for the clinical wisdom that anti-depressants can work and can save lives―and that for individual patients, they can be even more effective than the research suggests." ―Tanya Marie Luhrmann, Watkins University Professor in the Anthropology Department at Stanford University, and author of When God Talks Back

About the Author

Peter D. Kramer is a psychiatrist, writer, and Brown medical school professor. Among his books are Against Depression, Should You Leave?, and the New York Times bestseller Listening to Prozac. His articles and book reviews have appeared in The New York Times, The Washington Post, Slate, and elsewhere.

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Ordinarily Well: The Case for Antidepressants