Before Prozac: The Troubled History of Mood Disorders in Psychiatry

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Overview

Psychiatry today is a barren tundra, writes medical historian Edward Shorter, where drugs that don't work are used to treat diseases that don't exist. In this provocative volume, Shorter illuminates this dismal landscape, in a revealing account of why psychiatry is "losing ground" in the struggle to treat depression.
Naturally, the book looks at such culprits as the pharmaceutical industry, which is not inclined to market drugs once the patent expires, leading to the endless introduction of new—but not necessarily better—drugs. But the heart of the book 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. If you can beat sugar pills, you get your drug licensed, whether or not it is actually better than (or even as good as) current medications, thus sweeping from the shelves drugs that may be superior but have lost patent protection. The book also examines the FDA's early power struggles against the drug industry, an influence-grab that had little to do with science, and which left barbiturates, opiates, and amphetamines all underprescribed, despite the fact that under careful supervision they are better at treating depression, with fewer side effects, than the newer drugs in the Prozac family. Shorter also castigates academia, showing how two forms of depression, melancholia and nonmelancholia—"as different from each other as chalk and cheese"—became squeezed into one dubious classification, major depression, which was essentially a political artifact born of academic infighting.
An astonishing and troubling look at modern psychiatry, Losing Ground is a book that is sure to spark controversy for years to come.

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Editorial Reviews

Doody's Review Service
Reviewer: Steven T. Herron, MD (University of Arizona Health Sciences Center)
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.
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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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