Rating: 
Summary: Deals with the right questions
Review: 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.
Rating:
Summary: Has This Work Been With Us Ten Years Already?
Review: I had a desire to go back and reread this work on the tenth anniversary of its publication. I was curious to see how Dr. Peter Kramer's magnificent essay of the mysteries of mood and matter had stood the test of time. I was also interested to see how far the psychiatric-pharmaceutical complex had come in the past decade in dealing with the scourge of depression and other mental disorders. But before I get too far ahead of myself, exactly what was it about this book that made it such a provocative success in 1993? Two factors come to mind almost immediately. The first is the remarkable story-telling and philosophical style of the author. Yes, the crux of this work was the ethical dilemma of physicians who for the first time possessed the legal and medicinal power to alter personality cosmetically. But we forget over the years that this book was much more than a pharmaceutical morality play. It was a fascinating look at the pioneers of the biotechnology era, a glimpse into the hit and miss processes whereby paradigms and hypotheses were transformed into molecular formulas. The author made lucid for the general public just how mysterious the matrix between the material and the metaphysical truly is. That the new psychotropic drugs could morph a wallflower into a grand dame was becoming evident, so to speak, but the reasons for the change remained well educated guesses, and nothing more, in 1993. Such a tale was both tantalizing and troubling, and no one before Kramer had quite animated psychiatry while circumscribing it in such an elegant way. The second attraction of this book was the drug itself, Fluoxetine, marketed under the brand name Prozac. Prozac was not the only member of new wave antidepressants, the Selective Serotonin Reuptake Inhibitors, or SSRI's, available in 1993. [Zoloft was on the market by then.] But Prozac intrigued the public for different reasons than it enthralled Dr. Kramer. Prozac had a public relations problem: allegedly it promoted suicide and other evils, charges easily discredited with time but not until the medication had run the Larry King/60 Minute gamut of journalistic fury. Kramer did for Prozac what the Crocodile Hunter would later do for venomous reptiles, remind us that though potent the SSRI's can be handled safely by trained professionals. It has been ten years since this work was published, and seventeen years since the appearance of Prozac. Have we grown in wisdom regarding the relation of mood and chemicals in the human nervous system, and have we seen a stampede of new clients looking for psychological facelifts from new generation psychotropics? To respond to the first question, pharmaceutical inquiry over the past decade has continued to focus upon the neurotransmitter model of cellular communication in the brain--the cute Zoloft TV cartoon of little bullets or messengers passing back and forth between mother ships. There is now question as to whether Serotonin is the only bullet in the holster, with researchers looking at the roles of dopamine and norepinephrine in the alteration of mood. Moreover, the SSRI's have proven effective over time with more disorders besides depression--everything from obsessions to pain management. But no new major theory of mood disorder has displaced those discussed by Kramer. The kindling theory of illness described by Kramer [110ff.] and the genetic disposition toward illness in successive generations of families seem to have created more interest in pediatric psychiatry and the importance of early intervention. What has certainly changed in a decade is Prozac's reputation; it is now the safe old plow horse of the stable, the only SSRI considered truly tolerable for minors. As to the second issue, personality enhancement, Kramer's worries may have been misplaced. Kramer was low keyed in his discussion of side effects, but the SSRI's have been bedeviled by them to the present day. Most notably the sexual side effects have put a damper upon elective use of the medication. Sexual impairment is a high price to pay for enhanced self confidence, though new formulations and time release capsules have ameliorated the side effects some. [The real stampede, ironically, has been toward Viagra.] But when push comes to shove, the past decade indicates that, bottom line, Americans continue to entertain a pharmaceutical Calvinism, a suspicion of medicine, and more recently, of the companies that make them. When I undertake a mental health assessment, the first question I get is inevitably: "You're not going to recommend drugs, are you?" One common example: parents resist stimulants for their ADHD children like the plague. Contrary to popular belief, America is not a country of eager pill poppers, and this has been true even before the recent surge in medicine costs. Pills are for "when you're sick." If anything, there is a thinly veiled contempt for medical interventions that enhance the human experience beyond convention. Evidently there is a national consensus that every man deserves a good erection. But buried deep in the national subconscious is the spirit of the Hippocratic Oath. Or, conceivably, we have taught people to "just say no" a little too indiscriminately where medication is concerned. But by and large cosmetic physical interventions still carry a certain stigma. There is a slight revulsion to the idea that Barry Bonds' 73 home runs were steroid enhanced, or that Pamela Anderson's prime assets are [or were] primarily silicone. There have been pharmaceutical betrayals, too, in the last ten years, notably Redux and Fen Fen. In retrospect Kramer's fears about the ethics of altering personality have been trumped by the inbred suspicion of the "quick fix." Who among us does not hold an innate suspicion of ads for "miracle weight loss?" A nation reluctant to eat a steady diet of meat to lose weight is probably not ready for instant personality remakes.
Rating: 
Summary: not a good book in my opinion
Review: I personally found this author's prose difficult to plow through, perhaps because of the abundance of sentences without enough commas. His prose simply doesn't flow. But that's probably a problem only I'd find. In any case, this book does raise a few good points that I find insanely inconsequential.
Rating:
Summary: not a good book in my opinion
Review: If you're wondering how Prozac effects people's personalities and who they are, aside from their depression treatment, this is the book to read. It has a lot of case studies of people on Prozac and how they changed (mostly for the better, surprisingly) as well as a lot of information on the history of antidepressants and psychological studies illuminating how depression and related illnesses manifest. If you want to know about alternatives to Prozac, there is some information on other antidepressants, but not much about modern ones, and nothing about herbal alternatives. But even if you don't want to be on Prozac, I would reccomend this book for understanding depression and the medication of it.
Rating: 
Summary: Raises some great questions
Review: 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 Bible tells us that the body is the mediator of moral action, not the initiator. It is the `equipment of the heart' (p. 40). Sinful thoughts and actions, in response to the temptations presented by stressful circumstances, can impact the body. Perhaps my failures to often respond with faith to 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.
Rating:
Summary: The king of psychiatry
Review: In my view, Kay Jamison ("An Unquiet Mind") is the queen of psychiatry and Peter Kramer is the king. He earned the title by writing "Listening to Prozac", which stands out as truly unique in the psychiatric literature. It is a combination of interesting case studies, biological data, and philosophical reflection. Kramer has great insight into the psyche and writes extremely well. The book will appeal to a broad audience of nearly anyone interested in how the mind works. In fact, it should be required reading for practically everyone! Avery Z. Conner, author of "Fevers of the Mind".
Rating: 
Summary: A great introduction to the physiology of antidepressants
Review: In this book DR. Kramer offers the layperson a great introduction to the physiological, psychological, and philosophical basis for understanding antidepressants. I was especially impressed with his writing style which makes this book entertaining as well as informative. He offers wonderful examples of his ideas from real patients he has treated. Some of the Philisophical issues raised is whether it is beneficial to "rob" people of their normal moods through medication. Both points of this issue are stated wonderfully on page 266. "To be opiated into a cacoon is one thing, but to be granted peace where once you were neurotically compelled is quite another: there are instances which contentment contains more autonomy than drive." Walker Percy, a psychiatrist is one who believes that anxiety is, "A summons to authentic existence, to be headed at any cost." Both sides of this issue are explored wonderfully in this book along with many other issues. A great read for anyone.
Rating:
Summary: Best book I've read on topic of depression and treatment
Review: Listening to Prozac bridges the gap between the medical profession and layperson, presenting cogent information about the effect of SRIs and the ever-broadening spectrum of mood and psychological disorders they can effectively treat. Kramer doesn't skirt the ethical issues, nor does he promote the use of of SRIs. He does recognize that thousands of doctors and millions of patients feel these drugs represent a true breakthrough in treating depression and mood disorders in many types of people. At the same time, he addresses the question of what we most of us call "character"--something that many believe to be fixed in an individual--and how it can undergo "change" during treatment with SRIs. This becomes an ethical and spiritual question (in addition to being a medical question). It is a question that was (is) fascinating to me.
Rating:
Summary: Best kind of non-fiction book
Review: Listening to Prozac is the best kind of nonfiction book: a book that meditates on large questions by focusing a laser eye on a a more specialized topic, in this case depression and its treatment. Kramer probes deeply into the symptoms and physiology of depression and its treatment with drugs and other means, but without letting his narrative run aground in technical muck. It's this constant probing that allow him to explore much more broad questions about modern American attitudes toward the personality, moods, and mental health, which are the real heart and soul of this book. People interested in better understanding depression will definitely benefit from this, but so will anyone with an interest in psychology at the close of the twentieth century.
Rating:
Summary: Listen Well
Review: Self-help literature can sometimes be hard on the reader: it's not usually very well written, relying on the need of the reader for information and help rather than style to seduce its audience. If you read this book expecting to be eased through an account of the SSRIs, then you'll be disappointed. But if you are interested in what a deeply thoughtful therapist can offer in the way of a philosophical, literary, and pharmacological exploration of the SSRI drugs, you'll love this book. Kramer's writing is compelling: he leads us through a history of the development of anti-depressant medication via a series of case studies that open up his central enquiry: what our we doing to our "selves" when we medicate? Kramer's book is, on balance, very positive about the impact of newer anti-depressants on the lives of depressed people. He is, however, cautious about the implication of these medications in a larger social context: are we giving people drugs merely to make them more peppy, more likeable? Are there personality types that are so privileged in our culture that we are now prescribing to effect personality changes? What might it mean when a patient on medication feels more "like themselves" than they did before chemical intervention? Kramer poses these questions through a gentle expository prose which nonetheless lays out their implications in all their complexity. His use of literary analogies -- in particular, the work of Walker Percy -- will strike a chord for those whose find fiction sometimes the best vehicle in which to explore questions of human social interraction. Listening to Prozac does, I'd suggest, offer help. It also provides much food for thought. Anyone whose life has been touched by SSRI medications will be intrigued by this book, and find something in it that speaks to them.
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