Listening to Prozac: The Landmark Book About Antidepressants and the Remaking of the Self, Revised Edition [Paperback]

Peter D. Kramer (Author)

Book Description

Release date: September 1, 1997

Since it was introduced in 1987, Prozac has been prescribed to nearly five million Americans. But what is Prozac? A medication or a mental steroid? A cure for depression, or a drug that changes personality? Reported to turn shy people into social butterflies and to improve work performance, memory, even dexterity, does Prozac work on character rather than illness? Are we using it cosmetically, to make people more attractive, more energetic, more socially acceptable? And what does it tell us about the nature of character and the mutability of self? With the addition of an afterword that gives us an up-to-date report on Prozac in America today, including his personal observations, reactions to his critics, and the latest scientific research, psychiatrist Peter Kramer reinforces what The New York Times calls 'an intelligent and informative book...which tells us new things about the chemistry of human character.'

Dr. Kramer was recently asked to guest host The Infinite Mind, a weekly public radio show focusing on the art and science of the human mind and spirit, behavior, and mental health. Listen to the show now.

Editorial Reviews

Amazon.com Review

Psychiatrist Peter Kramer's book Listening to Prozac created a sensation when it was released in 1993, and it remains the most fascinating look at the new generation of antidepressants. Kramer found that the changes in brain chemistry brought about by Prozac had a wide variety of effects, often giving users greater feelings of self-worth and confidence, less sensitivity to social rejection, and even a greater willingness to take risks. He cites cases of mildly depressed patients who took the drug and not only felt better but underwent remarkable personality transformations--which he (along with many of the book's readers) found disconcerting, leading him to question whether the medicated or unmedicated version was the person's "real" self. Kramer has been criticized for seeming to advocate Prozac over psychotherapy or as a way of achieving personality changes not directly related to the disease of depression, such as improving one's social confidence or job performance. In fact, he makes no such recommendations; he was simply the first popular writer to suggest that these changes might occur. (He answers those critics in the afterword to this 1997 edition.) For anyone considering taking antidepressants or wanting a better understanding of the effects these drugs are having on our society, Listening to Prozac is a very important book.

From Library Journal

Kramer, a practicing psychiatrist, finds that the antidepressant Prozac is a powerful drug that lifts the veil of depression from most patients without significant side effects. While he unquestionably supports the use of medication to alleviate illness, he questions using drugs to make a person feel "better than well." It is the remarkable ability of Prozac to create personality changes that he finds disturbing. Is it ethical to prescribe a drug that increases a person's self-confidence, resilience, and energy level without any ill effect, when there is no underlying manifestation of illness? What is the essence of personhood and what are the philosophical implications of using drugs to alter personality? Both Kramer's unequivocal endorsement of Prozac for the treatment of depression and the questions he raises about the use of drugs for mood alteration are controversial. A glossary would have been a useful addition for lay readers. Recommended.
- Carol R. Glatt, VA Medical Ctr. Lib., Philadelphia
Copyright 1993 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 448 pages
• Publisher: Penguin Books; Revised edition (September 1, 1997)
• Language: English
• ISBN-10: 0140266712
• ISBN-13: 978-0140266719
• Product Dimensions: 8.4 x 5.5 x 1 inches
• Shipping Weight: 12.6 ounces (View shipping rates and policies)
• Average Customer Review: 4.2 out of 5 stars  See all reviews (39 customer reviews)
• Amazon Best Sellers Rank: #155,001 in Books (See Top 100 in Books)
  • #11 in Books > Medical Books > Pharmacology > Neuropsychopharmacology
  • #18 in Books > Health, Fitness & Dieting > Psychology & Counseling > Psychopharmacology

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Most Helpful Customer Reviews

81 of 97 people found the following review helpful

5.0 out of 5 stars Has This Work Been With Us Ten Years Already? December 12, 2003

By Thomas J. Burns VINE™ VOICE

Format:Hardcover

I had a desire to go back and reread this work on the tenth anniversary of its publication. I was curious to see how Dr. Peter Kramer's magnificent essay of the mysteries of mood and matter had stood the test of time. I was also interested to see how far the psychiatric-pharmaceutical complex had come in the past decade in dealing with the scourge of depression and other mental disorders.

But before I get too far ahead of myself, exactly what was it about this book that made it such a provocative success in 1993? Two factors come to mind almost immediately. The first is the remarkable story-telling and philosophical style of the author. Yes, the crux of this work was the ethical dilemma of physicians who for the first time possessed the legal and medicinal power to alter personality cosmetically. But we forget over the years that this book was much more than a pharmaceutical morality play. It was a fascinating look at the pioneers of the biotechnology era, a glimpse into the hit and miss processes whereby paradigms and hypotheses were transformed into molecular formulas. The author made lucid for the general public just how mysterious the matrix between the material and the metaphysical truly is. That the new psychotropic drugs could morph a wallflower into a grand dame was becoming evident, so to speak, but the reasons for the change remained well educated guesses, and nothing more, in 1993. Such a tale was both tantalizing and troubling, and no one before Kramer had quite animated psychiatry while circumscribing it in such an elegant way.

The second attraction of this book was the drug itself, Fluoxetine, marketed under the brand name Prozac. Prozac was not the only member of new wave antidepressants, the Selective Serotonin Reuptake Inhibitors, or SSRI's, available in 1993.... [Zoloft was on the market by then.] But Prozac intrigued the public for different reasons than it enthralled Dr. Kramer. Prozac had a public relations problem: allegedly it promoted suicide and other evils, charges easily discredited with time but not until the medication had run the Larry King/60 Minute gamut of journalistic fury. Kramer did for Prozac what the Crocodile Hunter would later do for venomous reptiles, remind us that though potent the SSRI's can be handled safely by trained professionals.

It has been ten years since this work was published, and seventeen years since the appearance of Prozac. Have we grown in wisdom regarding the relation of mood and chemicals in the human nervous system, and have we seen a stampede of new clients looking for psychological facelifts from new generation psychotropics? To respond to the first question, pharmaceutical inquiry over the past decade has continued to focus upon the neurotransmitter model of cellular communication in the brain--the cute Zoloft TV cartoon of little bullets or messengers passing back and forth between mother ships. There is now question as to whether Serotonin is the only bullet in the holster, with researchers looking at the roles of dopamine and norepinephrine in the alteration of mood. Moreover, the SSRI's have proven effective over time with more disorders besides depression--everything from obsessions to pain management. But no new major theory of mood disorder has displaced those discussed by Kramer. The kindling theory of illness described by Kramer [110ff.] and the genetic disposition toward illness in successive generations of families seem to have created more interest in pediatric psychiatry and the importance of early intervention. What has certainly changed in a decade is Prozac's reputation; it is now the safe old plow horse of the stable, the only SSRI considered truly tolerable for minors.

As to the second issue, personality enhancement, Kramer's worries may have been misplaced. Kramer was low keyed in his discussion of side effects, but the SSRI's have been bedeviled by them to the present day. Most notably the sexual side effects have put a damper upon elective use of the medication. Sexual impairment is a high price to pay for enhanced self confidence, though new formulations and time release capsules have ameliorated the side effects some. [The real stampede, ironically, has been toward Viagra.] But when push comes to shove, the past decade indicates that, bottom line, Americans continue to entertain a pharmaceutical Calvinism, a suspicion of medicine, and more recently, of the companies that make them. When I undertake a mental health assessment, the first question I get is inevitably: "You're not going to recommend drugs, are you?" One common example: parents resist stimulants for their ADHD children like the plague. Contrary to popular belief, America is not a country of eager pill poppers, and this has been true even before the recent surge in medicine costs. Pills are for "when you're sick."

If anything, there is a thinly veiled contempt for medical interventions that enhance the human experience beyond convention. Evidently there is a national consensus that every man deserves a good erection. But buried deep in the national subconscious is the spirit of the Hippocratic Oath. Or, conceivably, we have taught people to "just say no" a little too indiscriminately where medication is concerned. But by and large cosmetic physical interventions still carry a certain stigma. There is a slight revulsion to the idea that Barry Bonds' 73 home runs were steroid enhanced, or that Pamela Anderson's prime assets are [or were] primarily silicone. There have been pharmaceutical betrayals, too, in the last ten years, notably Redux and Fen Fen. In retrospect Kramer's fears about the ethics of altering personality have been trumped by the inbred suspicion of the "quick fix." Who among us does not hold an innate suspicion of ads for "miracle weight loss?" A nation reluctant to eat a steady diet of meat to lose weight is probably not ready for instant personality remakes. Read more ›

28 of 33 people found the following review helpful

5.0 out of 5 stars A brilliant look at the implications of Prozac March 25, 1999

By A Customer

Format:Paperback

This author is truly eloquent. Although he covers subjects ranging from the experiences of his own clients to more scientific discussions of how biology plays into the experience of depression, it never once lost my attention. After reading this book, I felt like I'd gotten a little "self-help" as well as a nice mini-course in the psychology and biology of the human being. Read this if you love someone who is depressed and is trying "new" antidepressants, not just because it will give you a good grasp of the workings of the drugs themselves, but also because it illuminates beautifully the day to day experiences of dealing with depression.

20 of 23 people found the following review helpful

5.0 out of 5 stars fascinating--and indispensible if you're considering prozac February 17, 1999

By A Customer

Format:Paperback

The stories of Kramer's patients, and his meditations on our changing understanding of 'self' and happiness, are fascinating in their own right. Kramer has an engaging style and obviously reads a lot outside of his discipline which is nice! If you are considering Prozac, Kramer addresses all of the philosophical questions you might have about the decision. I never would have started taking Prozac had I not read this book, and like so many of Kramer's clients, the drug has really transformed my life.

27 of 33 people found the following review helpful

5.0 out of 5 stars Raises all the Right Questions March 2, 2004

By GLBT VINE™ VOICE

Format:Paperback|Amazon Verified Purchase

As someone who's been on Paxil for over a year, I've had many a conversation (with friends and with my therapist) about what it is, precisely, that Paxil (and it's buddies in the Prozac family) does. And should it be doing it? At what point is depression an "illness" that warrants medicated treatment and when is it simply a "normal" amount of bad feelings? Is Paxil a crutch? And if it is, does that mean that it shouldn't be used?

This book addresses these questions intelligently and honestly. One of the things I admire about the book is that it doesn't pretend to have answers. It suggests possibilities, yes, and the author will frequently offer his own opinions, but he's very upfront about his own discomfort with the "Miracle Cures" that Prozac, Paxil, etc. have brought about, and the questions these cures raise for the usefulness of therapy.

If you know anyone who's on any of these drugs or if you yourself are on them, I cannot recommend this book highly enough. Whatever your own opinion may be, I think you'll find this book offers a lot to think about.

22 of 27 people found the following review helpful

5.0 out of 5 stars Best book I've read on topic of depression and treatment October 29, 1998

By A Customer

Format:Paperback

Listening to Prozac bridges the gap between the medical profession and layperson, presenting cogent information about the effect of SRIs and the ever-broadening spectrum of mood and psychological disorders they can effectively treat. Kramer doesn't skirt the ethical issues, nor does he promote the use of of SRIs. He does recognize that thousands of doctors and millions of patients feel these drugs represent a true breakthrough in treating depression and mood disorders in many types of people. At the same time, he addresses the question of what we most of us call "character"--something that many believe to be fixed in an individual--and how it can undergo "change" during treatment with SRIs. This becomes an ethical and spiritual question (in addition to being a medical question). It is a question that was (is) fascinating to me.

13 of 15 people found the following review helpful

5.0 out of 5 stars Best discussion of the philosophy of psychopharmacology March 6, 1998

By [e-mail]

Format:Paperback

Any author who can speak persuasively of "psychopharmacological Calvinism" merits attention. I am a psychiatrist (perforce a psychopharmacologist) in private practice and teaching psychopharmacology to graduate students in a predominantly behaviorally oriented doctoral program in psychology. This is one of the textbooks required for the course, and springboards the best discussions of the semester. I disagree only with the author's position that we must conclude we can change personalities with Prozac because our current diagnostic criteria for depression don't include such "personality traits" as shyness. It would be helpful to readers of all backgrounds if he explored more thoroughly the methods by which our standard diagnostic criteria are chosen (1). With that single caveat, I wholeheartedly endorse this very well written, entertaining, rigorously reasoned, and unique book for anyone who wishes to see how to think about ethical and philosophical issues in science, particularly in patient care aspects of medicine in a managed care environment.

One additional caution; the author states very explicitly in the beginning of this work that he does not pretend to be presenting a complete and well-rounded view of Prozac-and I reiterate this warning the day we begin to study it in my course-yet my students may still complain that it paints too onesided a picture of Prozac. So read what the author says and believe it; it will save some pointless carping later on.

(1) Diagnostic and Statistical Manual of the American Psychiatric Association Ed 4 (DSM IV) American Psychiatric Press; criteria are not all inclusive but chosen to discriminate among various disorders.

-Phil Torrance MD (Diplomate in Psychiatry)