Before Prozac: The Troubled History of Mood Disorders in Psychiatry

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In this volume, Shorter presents a revealing account of why psychiatry is 'losing ground' in the struggle to treat depression. It focuses on an unexpected villain - the FDA, the very agency charged with ensuring drug safety and effectiveness. Shorter describes how the FDA permits companies to test new products only against placebo.
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Editorial Reviews

Doody's Review Service
Reviewer: Steven T. Herron, MD (Assurance Health and Wellness)
Description: Written as an expose of "modern" psychiatry, psychopharmacology, the pharmaceutical industry, and governmental intervention, this book explores various influences on the production of medications used to treat patients with mood disorders in the United States.
Purpose: The author attempts to examine the shortcomings of a promising beginning to the understanding of mood disorders and traces the problems forward to enable readers to comprehend how the field arrived at its current state.
Audience: Though targeted at a larger audience, much of this book is challenging for those unfamiliar with the field of psychiatry, the specifics of psychiatric research and statistical analysis, psychiatric diagnosis as assigned by the DSM-IV-TR, or psychiatric treatment.
Features: The author identifies three major sections in this work: the first being the introduction of medications used to treat psychiatric illness in the early 1950s; the second focusing on the FDA's power in steering the use of certain medications; and the third explaining the current state of affairs in psychopharmacology, including a chapter about how to begin to regain lost ground. There is one table, but no other illustrations, and the book ends with a glossary and annotated notes separated by chapter.
Assessment: It goes without saying there are numerous problems with the manner in which pharmaceuticals for mental illness are discovered, manufactured, and distributed in the United States and throughout the world. Much of the difference between what is permitted in the United States and in other industrialized countries is a result of what is approved for treatment by the FDA. And while it is important to expose the process and educate others about its shortcomings, it seems unrealistic to describe the procedure of drug approval as a huge conspiracy meant to pad the pockets of the pharmaceutical companies while simultaneously taking advantage of a naive and desperate public, all at the hands of hapless clinicians who are, by the author's description, nothing but dupes and mindless automatons who are either incapable, or unwilling, to think for themselves. In order to examine the global aspect of this problem, it seems likely there are other factors at play this author seems to have neglected, such as a legal system in the United States, which is unlike others in the world in that a huge liability is placed on the clinicians providing care, creating a very risk-averse physician population, as well as a general public that is led to believe pharmaceuticals will cure all ills with no reasonable expectation of legitimate side effects or other adverse events. Though some of the author's ideas are interesting and provocative, ultimately they are not based on hard evidence.
From the Publisher

"Excellent...informative and intriguing..."--New England Journal of Medicine

"...interesting and provocative..."--Doody's

"...Before Prozac is a nuanced, timely, and provocative book written by an incisive thinker at the height of his considerable intellectual powers. Prof. Shorter's powerful arguments demonstrate clearly the value of historical perspectives when evaluating current medical practices, and serve as a sobering reminder of the transitory nature of many psychiatric treatments and, indeed, psychiatric categorisations."--Irish Medical News

"I saw a patient not long ago with quite paralysing long-term periods of anxiety associated with depression and despair accompanied by suicidal thoughts... If I saw him now I would recommend Shorter's illuminating Before Prozac so he would have the full inside story."--The Lancet

"...engagingly written and informative."--PsycCRITIQUES

"Writing in a lively, exciting style packed with historical facts, Shorter brings to life the process of psychiatric drug discovery and development, enriching the fabric of his narrative wtih details about the persons involved....the book is a lot of fun to read."--The Journal of Clinical Investigation

"Shorter, a prolific medical historian, provides a detailed, lively history of what has been called the 'first set' of psychotropic drugs...the antipsychotics, anxiolytics, and antidepressants that showed up in the 1950s...It is a compellingly argued and erudite polemic..." -- American Journal of Psychiatry

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Product Details

  • ISBN-13: 9780195368741
  • Publisher: Oxford University Press, USA
  • Publication date: 10/28/2008
  • Edition description: New Edition
  • Pages: 320
  • Product dimensions: 6.30 (w) x 9.30 (h) x 1.00 (d)

Meet the Author

Edward Shorter is Hannah Chair in the History of Medicine and Professor of Psychiatry at the University of Toronto.

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Table of Contents

Main Drug Classes Discussed in Before Prozac

1 Introduction 3

2 Before Psychopharmacology 11

3 The First Drug Set 34

4 Power Play 73

5 Killer Drugs! 95

6 Death Sentences 126

7 "The Plague of Affective Disorders" 150

8 Losing Ground 169

9 What Now? 208

Glossary 215

Notes 229

Acknowledgment 289

Index 291

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