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Ordinarily Well: The Case for Antidepressants
Do antidepressants work, or are they glorified dummy pills? How can we tell? In Ordinarily W....
336 pages, Hardcover
First published August 23, 2016
About the author
Peter D. Kramer
16 books75 followersPeter D. Kramer is the author of eight books, including Ordinarily Well, Against Depression, Should You Leave?, the novels Spectacular Happiness and Death of the Great Man, and the international bestseller Listening to Prozac. Dr. Kramer hosted the nationally syndicated public radio program The Infinite Mind and has appeared on the major broadcast news and talk shows, including Today, Good Morning America, The Oprah Winfrey Show, Charlie Rose, and Fresh Air. His essays, op-eds, and book reviews have appeared in the New York Times, Wall Street Journal, Washington Post, and elsewhere. For nearly forty years, Dr. Kramer taught and practiced psychiatry in Providence, Rhode Island, where he isEmeritus Professor of Psychiatry and Human Behavior at Brown University. He now writes full time.
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Displaying 1 - 21 of 21 reviews
June 13, 2016
Like Gawande and Sacks, psychiatrist Peter Kramer's narrative is simultaneously clinically intriguing, historically relevant, and surprisingly down-to-earth. In describing antidepressant research, he explains and bridges the divides between psychotherapy and psychopharmacology, independent- and industry- sponsored research, and EBM and clinical pragmatism.
Being personally involved in industry-sponsored clinical research, I have had my notions challenged and changed due to Kramer's book. Previously in animal research, I was plainly told that every result can be a publishable result with the right PR team, and it is fine to deep-six results that frankly are too confusing. How widespread that idea is and how ethically questionable that is has only been laid bare to me after reading Ordinarily Well. It has strongly motivated me to regard research and publications with much more scrutiny.
Being personally involved in industry-sponsored clinical research, I have had my notions challenged and changed due to Kramer's book. Previously in animal research, I was plainly told that every result can be a publishable result with the right PR team, and it is fine to deep-six results that frankly are too confusing. How widespread that idea is and how ethically questionable that is has only been laid bare to me after reading Ordinarily Well. It has strongly motivated me to regard research and publications with much more scrutiny.
May 7, 2017
This isn't a book for the casual reader, or even for those who enjoyed Kramer's other books (like Listening to Prozac). Much of the book is a detailed analysis of the history of the study of antidepressants. As a science/medicine/mental health geek I found it fascinating.
The final few chapters were the payoff. Kramer concludes that antidepressant medicines are effective. For the details, read the book!
The final few chapters were the payoff. Kramer concludes that antidepressant medicines are effective. For the details, read the book!
June 24, 2016
This is well-worth reading if you've read any of those scary anti-depressant headlines recently (work the same as placebo! only good for severe depression!) and wondered, well shit, is that true? (Even if you know the answer because you know how they've helped you.)
It's not true, not really, and Kramer, who is no overprescribing pro-drug mouthpiece, lays out the facts and the non-facts. The non-facts come from his 30 years of clinical experience, where he describes how he's watched therapy and drugs work with his patients. Tbh, I find the non-facts more compelling than the facts; but it doesn't matter, because both illustrate that anti-depressants work, and that they're a net good for most patients.
It's not true, not really, and Kramer, who is no overprescribing pro-drug mouthpiece, lays out the facts and the non-facts. The non-facts come from his 30 years of clinical experience, where he describes how he's watched therapy and drugs work with his patients. Tbh, I find the non-facts more compelling than the facts; but it doesn't matter, because both illustrate that anti-depressants work, and that they're a net good for most patients.
May 3, 2026
Antidepressants are not a miracle drug — although they certainly can seem like a miracle to someone in the throes of depression and suicidal ideation — but rather they return someone to being ordinarily well. That is, antidepressants aren’t initiating a faux-high, but returning someone from a dark low to normal living and the ability to cope therein. But antidepressants for most of my lifetime have been derided as unnecessary, dangerous, and perhaps most bizarrely, useless, i.e., no better than dummy pills (a placebo). Peter D. Kramer, a psychiatrist, writer, and professor, seeks to dispel these arguments against antidepressants in his appropriately titled 2016 book, Ordinarily Well: The Case for Antidepressants. While his book is rather dense with discussions about the scientific literature (as well as the arc of the antidepressant controversy over the years) — statistics, various biases that, well, bias a study, confounds and comparators, meta-analysis, and so on — Kramer never loses sight of why he’s even making this argument: his patients and the betterment of theirs lives brought upon by antidepressants, or again, it’s perhaps more accurate to say, antidepressants provided the basis to return to ordinary living.
I take an antidepressant. My antidepressant is venlafaxine (75 mg), which is commonly known as Effexor. I’ve been taking it since the middle of 2021. I was previously taking a different SSRI, which I forget the name of, but which wasn’t working. What makes SSRIs particularly great comparatively as “second-generation” antidepressants is that they have a better-tolerated set of side effects than the tricyclics they’ve replaced, like imipramine, Kramer said. Effexor is thought to resemble the mechanism of action of tricyclics (targeting norepinephrine versus serotonin) so you’re achieving the first-generation benefit with the second-generation better-tolerated set of side effects. The additional benefit of the SSRIs is maintenance. That’s where I’m at now: the extended use of Effexor. To me, the most illuminating part of Kramer’s deep dive into the scientific literature, and the argument therein favoring antidepressants, is that if they were truly “dummy pills,” then they wouldn’t have any maintenance efficacy. Which is to say, those who are trialed on a placebo relapse or have a recurrence of depression, whereas, by and large, those still taking the antidepressant do not. The classic placebo effect people think of, whereby people improve in response to “inert intervention,” or the placebo, for a bevy of reasons (the impact of pill taking, doctorly authority, a clinical setting, etc.) do experience “transient early improvement,” but not sustained curing, which is the point here. As Kramer notes, “Every randomized, controlled trial finds that staying on medicine protects against further episodes.” This doesn’t mean Kramer never tapers a patient off of medication or otherwise tinkers with their medication — some patients he tapers the dosage during the spring/summer and reups it during the autumn/winter — but it does mean he’s trying to be patient-oriented.
In addition to the patient-oriented impetus for why Kramer felt impelled, I think, to offer this defense of antidepressants, is a direct argument he faced that he was dealing largely in anecdotes instead of research. Of course, anecdote is an interesting dynamic when we’re talking about psychotherapists who are in the clinical space, or the frontlines, dealing with real people and real cases of depression and other mood disorders. Anecdotes can be helpful! I liked Kramer’s framing of the argument as, “The antithesis of science is not anecdote, but ideology.” That isn’t to say his detractors are all operating with ideologically skewed animus toward antidepressants, but some surely are (just as some in defense of antidepressants are in the pocket of Big Pharma, as it were). That animus’s wellspring is a disdain for Big Pharma, its pressure on the scale of good science, and the scandals and ethical lapses therein. I also think there is something to be said for the distorting effects, or perverse incentives, of the Food and Drug Administration, which approves antidepressants. Kramer zeroes in on how the perverse incentive plays out, “The research submitted to the FDA, in other words, is not designed to demonstrate new drugs’ optimum efficacy. It is designed to produce two successful trials quickly in settings that retain patients and avert disastrous outcomes.” That is, to get through the onerous and expensive FDA process rather than necessarily reflect a true accounting of a drug’s efficacy. But I could digress on the FDA question.
Back to anecdote, Kramer’s impression (which is like a collection of anecdotes or observations of said anecdotes) is that end-of-the-line depression, or depression that is “treatment-resistant,” is less common in part because we’ve gotten better at treating depression early, and better yet, treating patients early with antidepressants rather than letting people suffer through it, which used to be a more prevalent course of treatment than I realized. An administrator at a psychiatric hospital in Maryland explained why he was withholding medication from one of his patients, who would go on to sue the hospital for negligence, “I told him that he needed every neuron to absorb what we are telling him here and that medication would interfere with that.” Oof. That, I think, is one of the stigmas around antidepressants as a treatment for depression: that it zombifies you, essentially, or numbs you to truly experiencing the world anymore. Kramer is diametrically opposed to such thinking, as I’ve noted, arguing that antidepressants enable you to experience the world again, ordinarily well. To put in his words, “Medicine acts as a catalyst, allowing for thriving under the ordinary constraints of the culture.” So, some depressions symptoms may persist at a low-level, but we are able to continue on, nonetheless. That has been my experience. Particularly, Kramer notes that suicidal ideation after beginning antidepressants takes on the hue of an alien time and thinking. Indeed, that aligns with my experience as well.
I’m not smart enough to evaluate all the in-the-weeds aspects of the research Kramer discusses, but I do want to talk about one area he addresses, which is recruitment. Recruitment into clinical research studies about the efficacy of antidepressant medication contrasted with placebos can skew the results, i.e., diminishing the positive effects of the former. That is, if you recruit people who are not actually depressed, then the ceiling for recovery, or engendering remission, isn’t as great, level-setting the antidepressant medication with the placebo. I thought about this in my own experience — again, I also rely on anecdote — with a clinical research study into severe depression. I was initially denied entry because I didn’t meet their determination of severe depression (whatever scale or determinants they were using). However, they changed course and allowed me in. Did my inclusion skew the results in some way? Or was there a way for them to account for such a variable? The bottom line, I think, is what Kramer states: that typically depressed patients do not sign on as subjects in candidate-drug trials. If I was actually experiencing severe depression, as I have previously, I never would have entered that research trial! Alas.
Another of the more interesting findings Kramer brought to the forefront, which counteracted my own anecdotal thinking, is that psychotherapy and antidepressant medication are not necessarily additive, nor is exercise, diet, etc. with medication. That is, if I understood Kramer correctly, for depression symptom relief, most of what medication and talk therapy accomplished together could be done by medication alone, i.e., that antidepressant medication and psychotherapy are not additive. Just last week, I talked about how holistically important to my recovery from depression I thought antidepressant medication, talk therapy, diet, and exercise all were. Are they not actually additive? In other words, were I to have only taken the Effexor sans talk therapy, diet, and exercise, would I have recovered from the symptoms of depression the same? Obviously, talk therapy, and certainly, diet and exercise, have their own benefits separate from depression per se, but in an additive context, it’s an interesting question. As one example of the dubiousness of the connection between exercise and abating depression symptoms, Kramer notes that people who enjoy exercise are less emotionally vulnerable, which means, they are less likely to dropout of the study, and therefore, their presence at the end skews the efficacy. And it’s also obviously not the case that Kramer is discounting psychotherapy; he is a psychotherapist! (Which is further interesting since the other direction tends to happen wherein psychotherapists discount psychopharmacology, clearly.) In fact, at the beginning of the book, Kramer talks about a patient’s case study, who he calls Adele, who he treated when he was still new to the field. He felt that imipramine made his level of skill sufficient, meaning, since he was new, it made his therapy better for her or at least, better able to meet the occasion. That also made me wonder what talk therapy, which again, I found helpful, would’ve been like after taking Effexor (I was still on the first antidepressant medication at the time).
I’ve never quite understood the outright aversion to medication. If a treatment intervention can return you to ordinary wellness, why would one abstain? The ready analogy to me, as someone who also wears glasses, would be like abstaining from wearing glasses, despite their promise to restore ordinary well eyesight (indeed, plenty of people do, but that’s likely for aesthetic reasons and social issues than an actual aversion to the treatment intervention). That isn’t to discount side effects of medication use, especially long-term, but weighed against the other side — people suffering through debilitating depression and/or dying by suicide — it seems, to use an awkward pun, a no-brainer. Kramer’s book is a balm partly against medication pessimism, but also a clarion call for always keeping in mind the patient. The scientific literature is what is it, and it continues to matter, if it’s rigorous and well-done, but we are also talking about real lives and real patients with real suffering, who have the opportunity to be ordinarily well again. We should give them that chance.
I take an antidepressant. My antidepressant is venlafaxine (75 mg), which is commonly known as Effexor. I’ve been taking it since the middle of 2021. I was previously taking a different SSRI, which I forget the name of, but which wasn’t working. What makes SSRIs particularly great comparatively as “second-generation” antidepressants is that they have a better-tolerated set of side effects than the tricyclics they’ve replaced, like imipramine, Kramer said. Effexor is thought to resemble the mechanism of action of tricyclics (targeting norepinephrine versus serotonin) so you’re achieving the first-generation benefit with the second-generation better-tolerated set of side effects. The additional benefit of the SSRIs is maintenance. That’s where I’m at now: the extended use of Effexor. To me, the most illuminating part of Kramer’s deep dive into the scientific literature, and the argument therein favoring antidepressants, is that if they were truly “dummy pills,” then they wouldn’t have any maintenance efficacy. Which is to say, those who are trialed on a placebo relapse or have a recurrence of depression, whereas, by and large, those still taking the antidepressant do not. The classic placebo effect people think of, whereby people improve in response to “inert intervention,” or the placebo, for a bevy of reasons (the impact of pill taking, doctorly authority, a clinical setting, etc.) do experience “transient early improvement,” but not sustained curing, which is the point here. As Kramer notes, “Every randomized, controlled trial finds that staying on medicine protects against further episodes.” This doesn’t mean Kramer never tapers a patient off of medication or otherwise tinkers with their medication — some patients he tapers the dosage during the spring/summer and reups it during the autumn/winter — but it does mean he’s trying to be patient-oriented.
In addition to the patient-oriented impetus for why Kramer felt impelled, I think, to offer this defense of antidepressants, is a direct argument he faced that he was dealing largely in anecdotes instead of research. Of course, anecdote is an interesting dynamic when we’re talking about psychotherapists who are in the clinical space, or the frontlines, dealing with real people and real cases of depression and other mood disorders. Anecdotes can be helpful! I liked Kramer’s framing of the argument as, “The antithesis of science is not anecdote, but ideology.” That isn’t to say his detractors are all operating with ideologically skewed animus toward antidepressants, but some surely are (just as some in defense of antidepressants are in the pocket of Big Pharma, as it were). That animus’s wellspring is a disdain for Big Pharma, its pressure on the scale of good science, and the scandals and ethical lapses therein. I also think there is something to be said for the distorting effects, or perverse incentives, of the Food and Drug Administration, which approves antidepressants. Kramer zeroes in on how the perverse incentive plays out, “The research submitted to the FDA, in other words, is not designed to demonstrate new drugs’ optimum efficacy. It is designed to produce two successful trials quickly in settings that retain patients and avert disastrous outcomes.” That is, to get through the onerous and expensive FDA process rather than necessarily reflect a true accounting of a drug’s efficacy. But I could digress on the FDA question.
Back to anecdote, Kramer’s impression (which is like a collection of anecdotes or observations of said anecdotes) is that end-of-the-line depression, or depression that is “treatment-resistant,” is less common in part because we’ve gotten better at treating depression early, and better yet, treating patients early with antidepressants rather than letting people suffer through it, which used to be a more prevalent course of treatment than I realized. An administrator at a psychiatric hospital in Maryland explained why he was withholding medication from one of his patients, who would go on to sue the hospital for negligence, “I told him that he needed every neuron to absorb what we are telling him here and that medication would interfere with that.” Oof. That, I think, is one of the stigmas around antidepressants as a treatment for depression: that it zombifies you, essentially, or numbs you to truly experiencing the world anymore. Kramer is diametrically opposed to such thinking, as I’ve noted, arguing that antidepressants enable you to experience the world again, ordinarily well. To put in his words, “Medicine acts as a catalyst, allowing for thriving under the ordinary constraints of the culture.” So, some depressions symptoms may persist at a low-level, but we are able to continue on, nonetheless. That has been my experience. Particularly, Kramer notes that suicidal ideation after beginning antidepressants takes on the hue of an alien time and thinking. Indeed, that aligns with my experience as well.
I’m not smart enough to evaluate all the in-the-weeds aspects of the research Kramer discusses, but I do want to talk about one area he addresses, which is recruitment. Recruitment into clinical research studies about the efficacy of antidepressant medication contrasted with placebos can skew the results, i.e., diminishing the positive effects of the former. That is, if you recruit people who are not actually depressed, then the ceiling for recovery, or engendering remission, isn’t as great, level-setting the antidepressant medication with the placebo. I thought about this in my own experience — again, I also rely on anecdote — with a clinical research study into severe depression. I was initially denied entry because I didn’t meet their determination of severe depression (whatever scale or determinants they were using). However, they changed course and allowed me in. Did my inclusion skew the results in some way? Or was there a way for them to account for such a variable? The bottom line, I think, is what Kramer states: that typically depressed patients do not sign on as subjects in candidate-drug trials. If I was actually experiencing severe depression, as I have previously, I never would have entered that research trial! Alas.
Another of the more interesting findings Kramer brought to the forefront, which counteracted my own anecdotal thinking, is that psychotherapy and antidepressant medication are not necessarily additive, nor is exercise, diet, etc. with medication. That is, if I understood Kramer correctly, for depression symptom relief, most of what medication and talk therapy accomplished together could be done by medication alone, i.e., that antidepressant medication and psychotherapy are not additive. Just last week, I talked about how holistically important to my recovery from depression I thought antidepressant medication, talk therapy, diet, and exercise all were. Are they not actually additive? In other words, were I to have only taken the Effexor sans talk therapy, diet, and exercise, would I have recovered from the symptoms of depression the same? Obviously, talk therapy, and certainly, diet and exercise, have their own benefits separate from depression per se, but in an additive context, it’s an interesting question. As one example of the dubiousness of the connection between exercise and abating depression symptoms, Kramer notes that people who enjoy exercise are less emotionally vulnerable, which means, they are less likely to dropout of the study, and therefore, their presence at the end skews the efficacy. And it’s also obviously not the case that Kramer is discounting psychotherapy; he is a psychotherapist! (Which is further interesting since the other direction tends to happen wherein psychotherapists discount psychopharmacology, clearly.) In fact, at the beginning of the book, Kramer talks about a patient’s case study, who he calls Adele, who he treated when he was still new to the field. He felt that imipramine made his level of skill sufficient, meaning, since he was new, it made his therapy better for her or at least, better able to meet the occasion. That also made me wonder what talk therapy, which again, I found helpful, would’ve been like after taking Effexor (I was still on the first antidepressant medication at the time).
I’ve never quite understood the outright aversion to medication. If a treatment intervention can return you to ordinary wellness, why would one abstain? The ready analogy to me, as someone who also wears glasses, would be like abstaining from wearing glasses, despite their promise to restore ordinary well eyesight (indeed, plenty of people do, but that’s likely for aesthetic reasons and social issues than an actual aversion to the treatment intervention). That isn’t to discount side effects of medication use, especially long-term, but weighed against the other side — people suffering through debilitating depression and/or dying by suicide — it seems, to use an awkward pun, a no-brainer. Kramer’s book is a balm partly against medication pessimism, but also a clarion call for always keeping in mind the patient. The scientific literature is what is it, and it continues to matter, if it’s rigorous and well-done, but we are also talking about real lives and real patients with real suffering, who have the opportunity to be ordinarily well again. We should give them that chance.
August 15, 2022
In light of the ongoing controversies about anti-depressants, I am happy to have found this book. I couldn't understand what to believe, how is it that so many people loudly decry anti-depressants online when my patients thank god for its existence? How is it so many people talk about horrible withdrawals online when my patients seem to stop it all the time with minimal difficulty? Were anti-depressants really no more effective than placebo? I couldn't imagine placebo working for a severe psychotic depression. If we didn't use these drugs, how else did society plan to manage depression, anxiety, OCD and many more illnesses? Some people showed such an outsized faith in psychotherapy that I wondered if they had ever even attempted it in a patient with severe depression or OCD, let alone even met such a patient. I wanted an answer to all these questions in my head. This book greatly helped calm my unease. Dr. Kramer narrates the history of antidepressant discovery and research. He painstakingly dissects the main issue raised by critics - that anti-depressants are only a placebo, in a simple manner. This book offered me tools to understand the research. It is unlikely that I would have understood as well if I had read the articles and statistical conundrums myself without his simplification. This book taught me a lot about trials -the reality of recruitment, the differential sieve, baseline score inflation, additivity of placebo etc., concepts that I had not come across in my three year residency training. I aspire to be a psychiatrist like him, prescribe minimally, taper frequently, but always use when necessary. I highly recommend this book to all psychiatrists.
February 6, 2017
I wanted to read this because anti-depressants have not worked for me. I have tried around ten or so of them, and had mostly bad side effects and no lifting of depression. I had also read a lot about the case against them (after trying them), about the unpublished studies that show how poor the outcomes actually are, the placebo effect and how exercise is just as, or more, effective.
By reading this book, I learned about how drug trials work, the history of the first anti-depressant, more about the placebo effect and different legal battles regarding the drug's use. I also learned some more about my own type of depression, the chronic dystonia. He also discussed the "double depression"-- when a chronically depressed person slips into a major depressive episode. That describes the last two years for me. I want to read his other book, Against Depression.
I also took away the idea that antidepressants seem to make the brain more resilient, and thus able to repair itself from the real damage of depression, rather then working by the commonly discussed "correcting" of a neurochemical imbalance.
In all, I felt the book was well-written and a good counterpoint to the wave of anti- anti-depressant lit out there. I still won't (in the foreseeable future) be using them, but this was an informative read.
By reading this book, I learned about how drug trials work, the history of the first anti-depressant, more about the placebo effect and different legal battles regarding the drug's use. I also learned some more about my own type of depression, the chronic dystonia. He also discussed the "double depression"-- when a chronically depressed person slips into a major depressive episode. That describes the last two years for me. I want to read his other book, Against Depression.
I also took away the idea that antidepressants seem to make the brain more resilient, and thus able to repair itself from the real damage of depression, rather then working by the commonly discussed "correcting" of a neurochemical imbalance.
In all, I felt the book was well-written and a good counterpoint to the wave of anti- anti-depressant lit out there. I still won't (in the foreseeable future) be using them, but this was an informative read.
March 23, 2018
An important corrective to a lot of the overblown critiques, some of which amount simply to pill-shaming.
December 7, 2019
I was captivated by Listening to Prozac when I read it like a decade ago, so I was curious about Peter’s followup. This book lays out Peter’s argument that antidepressants really do help a lot of people and powerfully forestall or delay what used to be progressive diseases of the mind that completely debilitated and killed a lot of people. His argument aims to counter popular misconceptions that antidepressants are no better than placebos or exercise. He makes a pretty strong case, pointing out the issues with placebo-controlled studies (or more accurately, how these studies get interpreted), the fudging that happens within drug trials, the lessbo effect, and a lot more. I really learned a lot about drug trials and studies by reading this — it was pretty fascinating. Recommended if you’re curious about the mind 💊
September 26, 2024
The book teaches readers to be cautious when interpreting studies, even meta-analyses and randomized controlled trials, and emphasizes that personal experience often outweighs other forms of evidence.
For example, I appreciated how the author discusses the link between exercise and better mental health, which many studies support. However, the author suggests that the causality might be reversed—perhaps people with good mental health are more likely to maintain an exercise routine, rather than exercise being the cause of improved mental health.
I would have preferred if the book included counterarguments to this perspective, presenting both sides more thoroughly and allowing readers to draw their own conclusions.
For example, I appreciated how the author discusses the link between exercise and better mental health, which many studies support. However, the author suggests that the causality might be reversed—perhaps people with good mental health are more likely to maintain an exercise routine, rather than exercise being the cause of improved mental health.
I would have preferred if the book included counterarguments to this perspective, presenting both sides more thoroughly and allowing readers to draw their own conclusions.
This entire review has been hidden because of spoilers.
April 29, 2018
Too boring and repetitive to finish. Or I guess I agreed with him right off the bat and didn’t need the remainder of the book for the author to prove his case.
June 4, 2025
a little beyond my academic interest but I bet my husband would LOVE it.
September 6, 2025
I thought this would be more about patients and less about how to set up a case study, but informative nevertheless!!
July 20, 2016
I read “Listening to Prozac” in the late 90’s so was curious to see what Dr.Kramer had to add to the original book. I was pleasantly surprised as he addressed many of the issues brought to the fore in the national media since then. In Ordinarily Well, Dr. Kramer examines drug research and his own direct practice with very real patients. Cites that the skepticism towards the efficacy of antidepressants is skewed not only in drug trials but preconceived notions of the public on the stigma of mental health concerns. Described patient encounters in the book are met with empathy by the doctor who never loses sight that his patients have a destructive illness, like diabetes, that affect the patient’s behavior, feelings, careers families and quality of life. Kramer never loses sight of patients. He writes with empathy about his clinical encounters. These patients as well as the entire human race deserve to be ordinarily well and antidepressants give the patients that opportunity. Dr. Kramer also accents the need of clinicians to treat each patient with unique care in that with some a medication will work, but others need a different one. Always with supplementation of talk therapy which clarifies the goal, values and constraints of a glorious life. Making all work with the human mind i.e. medication management, talk therapy, exercise, eating/sleeping well a work of love and faith.
August 14, 2016
Ordinarily Well does an amazing job of illustrating the caution we should exercise when we see splashy headlines about psychopharmacueticals. There's a wealth of history about the development of the research methodology and the growth of an industry.
I really enjoyed the care Kramer took in explaining the differences in trials, statistical tools, and comparative analyses. He unpacks concepts like placebo effect, additivity, efficacy, diagnostic scales (Hamilton), effect size, and counterfactuals in an accessible and compelling way.
The structure of the book also allows for a sense of contemplation and reflection- what have the decisions made by the research community, pharma companies, medical professionals, and media done to shape our understanding of mental health? What could it have been like if other ideas had flourished?
Like many non-fiction books I read, I do felt like I ran out of juice toward the end. Still worth a read, although I suspect if you put it down 2/3 of the way through, you'll still take away the big picture.
I really enjoyed the care Kramer took in explaining the differences in trials, statistical tools, and comparative analyses. He unpacks concepts like placebo effect, additivity, efficacy, diagnostic scales (Hamilton), effect size, and counterfactuals in an accessible and compelling way.
The structure of the book also allows for a sense of contemplation and reflection- what have the decisions made by the research community, pharma companies, medical professionals, and media done to shape our understanding of mental health? What could it have been like if other ideas had flourished?
Like many non-fiction books I read, I do felt like I ran out of juice toward the end. Still worth a read, although I suspect if you put it down 2/3 of the way through, you'll still take away the big picture.
October 4, 2016
not certain how widespread the appeal would be. He tells some anecdotes re patients from his practice, but for the most part it's a (very) deep dive into clinical trials [and meta-analyses of them] of antidepressant medication. Major aim is to dispute two arguments that have gained currency in recent years, namely:
1. much of the impact of antidepressant meds is a placebo effect
2. antidepressants are only useful [or at any rate more useful than placebo] for severe depression, not the much more common mild/moderate range
Brings to bear research on depression secondary to other illnesses, selection biases caused by how clinical trials are run to get FDA approval, short-form vs. full Hamilton Rating scale for depression as an outcome variable, and much more.
one-sided discussion, and I don't follow the primary literature on this topic much anymore, so I'd be curious to see a rebuttal from someone on the other side, but for what it's worth just seeing this author's take it seemed generally convincing and logical.
1. much of the impact of antidepressant meds is a placebo effect
2. antidepressants are only useful [or at any rate more useful than placebo] for severe depression, not the much more common mild/moderate range
Brings to bear research on depression secondary to other illnesses, selection biases caused by how clinical trials are run to get FDA approval, short-form vs. full Hamilton Rating scale for depression as an outcome variable, and much more.
one-sided discussion, and I don't follow the primary literature on this topic much anymore, so I'd be curious to see a rebuttal from someone on the other side, but for what it's worth just seeing this author's take it seemed generally convincing and logical.
July 22, 2016
just couldn't get into this one
kramer wrote this (i think?) in reaction to psychiatrists and others in the field saying that antidepressants don't work
and it's sort of a comparison between super scientific, double blinded placebo multi-armed studies that provide you with statistics and data and "facts"
and anecdotal medicine passed from clinician to clinician, which those stat junkies think is not so great
but it turns out psychiatric studies don't necessarily come up with perfect results because people are involved in them, people being notoriously not perfect
and you know, these are things i already know, and even though i enjoyed the insight into the rift between clinicians and researchers, it wasn't enough to hold my attention at this particular point in my life
this isn't a bad book, just not the book for me right now
kramer wrote this (i think?) in reaction to psychiatrists and others in the field saying that antidepressants don't work
and it's sort of a comparison between super scientific, double blinded placebo multi-armed studies that provide you with statistics and data and "facts"
and anecdotal medicine passed from clinician to clinician, which those stat junkies think is not so great
but it turns out psychiatric studies don't necessarily come up with perfect results because people are involved in them, people being notoriously not perfect
and you know, these are things i already know, and even though i enjoyed the insight into the rift between clinicians and researchers, it wasn't enough to hold my attention at this particular point in my life
this isn't a bad book, just not the book for me right now
February 7, 2017
Lots of information on studies and how they are mishandled. The book is one big case for antidepressants and puts all the myths to rest.
December 20, 2016
A psychiatrists take on anti-derpessants from both a personal view (what he has seen in practice) and a scholarly view (what does the research say.) Interesting history of how anti-depressants were developed and used also.
January 9, 2017
This book should be called "The Case Study for Antidepressants," or something like that. 127 pages in, and as far as I can tell, this is a tale about the history of antidepressants. I wonder when the part comes in that the author makes the case...
July 2, 2016
Although somewhat clinical to read, it was extremely informative.
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December 22, 2016couldn't get through it
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