Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, November 30, 1993 TAG: 9311300145
SECTION: EXTRA PAGE: 6 EDITION: METRO
SOURCE: By ELINOR J. BRECHER KNIGHT-RIDDER NEWSPAPERS
DATELINE: LENGTH: Medium
"No one in his right mind believes a book will do what this book has done - this is complex stuff," says Kramer, who wrote "Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self."
Indeed, one would think there'd be a limited audience for a book about the history of psychopharmacology, and even for the more intriguing philosophical discussion about the use of medication to alter basic temperament - and one would be right.
That's not why Kramer's controversial book about the hottest-selling antidepressant of all time has been on the New York Times bestseller list for 18 weeks.
Tess is why. And Sam, Allison, Hillary, Julia and the rest of the psychotherapy patients for whom Kramer prescribed the drug, whose often revolutionary - and unexpected - personality changes he chronicles.
Readers "see themselves in these stories . . . and seem more open to biological explanations [of depression] now," says Kramer, who practices in Providence, R.I.
His discussion of troublesome personality traits such as "rejection sensitivity" doubtless strikes a chord with many readers who never even knew that what affects them has a name.
"We all react to disappointments, even minor ones," writes Kramer, 45. "A date stands us up. A colleague makes a cutting remark. . . . Always there is a visceral response: the sinking in the stomach, a feeling of weakness, confusion of thought, a momentary sense of sadness and world-weariness. . . . For some this pain is worse than for others - lasts longer, paralyzes more thoroughly. They are not depressed, but they are vulnerable."
Therein lies one source of the controversy. Kramer raises questions that troubled him, even as he saw many patients become "better than well" on Prozac, shedding lifelong insecurities and dreads that had trapped them in misery: Will Prozac inevitably become "cosmetic pharmacology," used to alter personality and behavior rather than treat pathology? If medication makes you feel good, is taking it morally wrong? Should it be used for minor depression, as a "mood brightener," though that's not the use for which it's approved? Can, or should, medication replace psychotherapy altogether?
On the latter, Kramer hardly thinks so. He feels that a combination of medication and therapy "is really where it's at."
Eli Lilly and Co., which makes Prozac, addressed several of the issues in a statement released after the book was published: "While Lilly is pleased to hear of patients who respond positively to medication for serious medical conditions, Dr. Kramer's case examples and discussions often include the use of Prozac for indications beyond those approved by regulatory agencies."
Kramer says Lilly isn't accusing him of misusing the drug. In fact, he says, the federal Food and Drug Administration is considering a company request to expand approved usage to many of the conditions for which he has prescribed it.
"Is Prozac a good thing?" he asks in the book. "By now, asking about the virtue of Prozac [not only] in severely depressed patients but, rather . . . to alter personality - may seem like asking whether it was a good thing for Freud to have discovered the unconscious. Once we are aware of the unconscious, once we have witnessed the effects of Prozac, it is impossible to imagine the modern world without them."
Lilly reports that at least 10 million people worldwide have taken the drug, which raises the levels of serotonin in the brain, since it was approved in the United States six years ago. The company says 12 million adults in the United States alone suffer clinical depression, and Kramer cites a recent study reporting that 40 million Americans have been "very substantially blue" in recent weeks.
For a substantial number of patients, Prozac has accomplished far more than simply easing tough passages. They are "transformed," writes Kramer.
Of one patient, Tess, he writes: "I have never seen a patient's social life reshape so rapidly and dramatically. Low self-worth, competitiveness, jealousy, poor interpersonal skills, shyness, fear of intimacy - the usual causes of awkwardness - are so deeply ingrained and so difficult to influence that ordinarily change comes gradually if at all. But Tess blossomed all at once."
Kramer is convinced that Prozac's success has drawn a lot of money toward the study and treatment of mental illness, that it has increased understanding of "real depression."
Scattered reports of negative side effects have led many private insurers to deny all coverage to applicants who use it, and about 100 suits against Lilly involving the drug are pending; they allege that Prozac caused everything from rashes to homicide and suicide. Lilly spokeswoman Kelly Weston says 58 civil suits have been dismissed, none has gone to trial, and none has been settled. While the drug didn't work for all his patients who took it, Kramer says he didn't have any "Frankenstein monster cases."
by CNB