Listening to Prozac: Book Review

            Listening to Prozac describes Dr. Peter D. Kramer’s encounters as a psychiatrist with the 1990 FDA approved SSRI, Prozac. Kramer first describes several success stories of his patients trying this new selective serotonin reuptake inhibitor. With few side effects compared to the previous antidepressants such as a MAOIs and imipramine, the patient’s depressive symptoms soon subsided. He then goes on to discuss the theories and studies behind Prozac, depressive symptoms, ethics of psychiatric drugs and human behavior.1

            Each of Kramer’s patients had a different pronounced symptom but was still prescribed Prozac. In this book, it seemed that Prozac was capable of ameliorating multiple psychiatric problems such as depression, OCD, over sensitivity, low self-esteem, and high stress.1 Prozac’s main use is to treat minor depression. However, these individual cases suggested Prozac to be an all-purpose drug. All patients recovered well and improved their quality of life. Prozac had only been in use for about three years when this book was written. Perhaps, the definite or most effective use of Prozac was not determined until after Listening to Prozac was published.

            These patients underwent not only drug treatment but also psychotherapeutic treatment. A patient would come to Dr. Kramer describing how their mood on and off of Prozac. During therapy and under mediation, patients were able to better cope with their every day problems. The importance of Prozac was more highly attributed to the patient’s recovery instead of therapy. The most optimal results are achieved through this combination where patients use a medication to help them reach a cognitive sense of self-understanding and a higher degree of maturity in therapy. I do not feel this point was stressed enough in Listening to Prozac. Of course the main focus of the book was Prozac and the benefits of mediation, but to imply that medication alone alleviates negative symptoms relays a false understanding of the psychiatric and psychological world.

            In class, we have also discussed the beneficial effects of combined therapy and medication. An interesting point raised in class discussion was that combined medication and therapy is an expensive process that is not easily obtainable for all patients. Therefore, emphasis should be placed on the effectiveness of medication alone. After all, people on medication tend to demonstrate the ability to reason through their problems on their own and without the aid of a therapist. A lot of self-understanding comes from self-revelation about one’s personal issues. Medication facilitates this process and perhaps therapy could possibly be forgone, though it is not recommended. In most of the cases described by Dr. Kramer, his patients were referred to him by social workers. Therefore, his patients did have financial issues and perhaps extensive therapy was not affordable. As a result, Prozac was the main aspect of their treatment and therefore the primary emphasis of Kramer’s research.

            When reading this book, I did not find Prozac to be most advanced antidepressant as it was described to be. I feel this book is outdated because several more advances have been made in the field that renders Prozac inferior and rudimentary in comparison. As of now, there are several more antidepressant families: selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors.3 Each works on the brain’s neurotransmitters to correct a chemical imbalance that causes depressive symptoms. SNRIs and SSRIs are more recently in the market than the MAOIs and tricyclic antidepressants mentioned in Listening to Prozac. Interestingly enough Kramer mentions a theory about norepinephrine’s significance in depression. From my point of view, norepinephrine’s role in depression is not as much of a theory to me because of the SNRI marketing. Drugs such as venlafaxine, nefazodone, and desipramine are FDA approved and considered to work on norephinephrine along with serotonin.4 Between 1993, when Listening to Prozac was published, and today, some of Kramer’s thoughts and mentioned theories seem obsolete.

            This is not to diminish the significance of Prozac. Compared to its predecessors, Prozac had fewer and less detrimental side effects to the patient’s health. After all, the medication was ground breaking for its time by treating a variety of common and minor psychological problems. The drug was highly advertised and it became a popular subject in both psychiatry and psychology. As a groundbreaking medication, Prozac triggered the search for other effective antidepressants thus leading to the current day antidepressants I am familiar with.

            Kramer also mentions the biological specificity of Prozac on neurons. The serotonin works on a specific place on the neurotransmitter yet different psychological outcomes are possible.1 I related Kramer’s explanation of Prozac’s neurological impact to our class discussions. We learned that through intricate patterns of neuron activity, several possible outcomes are possible despite the same input to the neuron. Kramer also talked about the slight depressive relapse experience be some patients after being weaned off Prozac. I would have liked to better understand the biological and neurological reasons for this reoccurrence of old symptoms. According to my psychiatrist’s explanation, the body “learns” from the medication what the proper levels of serotonin should be. After the person has had positive progress on the medication, slowly weaning the patient off the drug allows the brain to remember and properly maintain the same level of serotonin it had while on the medication.2 For class discussion, I encourage students to be given a solid basis of antidepressant biological and neurological components.

            In general, I found the reading to be more psychological than neurobiological. I have taken a few psychology classes and found myself referring to neurological aspects covered in that class. I feel the rudimentary basics of neurobiology are not adequately covered in the Bryn Mawr Biology department. Perhaps for next year’s Neurobiology and Behavior class, one week could be dedicated to simple brain anatomy and neurotransmitters. Furthermore, the most commonly used FDA approved antidepressants should be learned. Therefore, all the students would be on the same level of understanding in the most basic aspects of neurobiology. However, Neurobiology and Behavior is a 200 level course focusing primarily on behavior, theories, and concepts; therefore, simple neurobiology should have been taught in the introductory biology classes. I have also suggested in my introductory biology class that neurobiology should be covered especially when neuroscience is offered as a concentration within the Bryn Mawr biology major.

            For next year’s Neurobiology and Behavior course, the benefits of combined therapy and medication should be highly emphasized. As seen in Listening to Prozac, medication was highly stressed rather than a combination. Personal self-understanding goes beyond the psychological improvement of medication. A person gains knowledge about his or herself, an ability once stifled by untreated depression.

Questions about how we perceive ourselves can be raised and will make an interesting class discussion. The culture and personal values tend to set standards for what the normal person should be. How does the world today differ from past values of what a “normal” person should be? Also the media plays a vital role in influencing people’s perception of “normal” in terms of psychology and neurobiology. Before, people taking psychiatric medication was not looked highly upon, but today people see advertisement for common antidepressants such as Zoloft, Lexapro, and Wellbutrin. The media and culture of the time influence the development of neurobiology and its popularity.

Works Cited

1. Kramer, Peter D. Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the      Remaking of the Self. Penguin Books USA INC: New York, 1993.

2. Jajodia, Kamal. lecture

3.http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/depression/antidepressants.aspx

4. http://www.answers.com/topic/serotonin-norepinephrine-reuptake-inhibitor