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Before Prozac: The Troubled History of Mood Disorders in Psychiatry Hardcover – October 28, 2008

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Edward Shorter (Author)
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Product Details

  • Hardcover: 320 pages
  • Publisher: Oxford University Press; 1 edition (October 28, 2008)
  • Language: English
  • ISBN-10: 0195368746
  • ISBN-13: 978-0195368741
  • Product Dimensions: 9.3 x 1 x 6.3 inches
  • Shipping Weight: 1.4 pounds (View shipping rates and policies)
  • Average Customer Review: 3.8 out of 5 stars  See all reviews (5 customer reviews)
  • Amazon Best Sellers Rank: #952,532 in Books (See Top 100 in Books)

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5.0 out of 5 starsA Bracing Critique of Contemporary Psychiatry
By Nicholas Watters on September 5, 2009
Format: Hardcover Verified Purchase
Shorter's critique is complicated and multifactorial (and he frequently gets distracted by historical curiosities), but lives may depend on it. The main thrust of his argument is that Psychiatry has not progressed as other medical specialties have, because the classification of illnesses and the medications used to treat them are inferior to the state of the art 40 years ago. This came about because 1. Major Depression was so broadly defined as to be a meaningless diagnosis, 2. The FDA decreed that drugs had to be indicated specifically for a particular use (antidepressant, antipsychotic, anxiolytic) 3. The early FDA arbitrarily wiped out or vilified whole classes of drugs as an exercise of power, and 4. the later FDA adopted a standard for efficacy of double-blind trials against placebo, without regard for relative effectiveness of other drugs.

The political document known as the DSM is certainly an easy target. Shorter's main objection is the classification of depressive disorders. He believes that clinically useful categories would be melacholic depression (what used to be called clinical depression, meaning slowed physical reactions, inability to get out of bed, high cortisol levels, sleep disturbance, anorexia, feelings of guilt) with the first line of treatment being tricyclic antidepressants; Atypical depression (increased sleep and appetite) with the first line of treatment being MAO inhibitors; and Neurotic Depression, covering a wide swath of the worried well (who now, along with the other two, now meet the diagnostic criteria for "Major Depressive Disorder"). For these, he marshals evidence that SSRI's can be effective, but not as much as meprobromate, librium, valium, chlorpromazine, and even ritalin, amphetamine and barbiturates.Read more ›
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5.0 out of 5 starsFascinating look at psychiatry in the 20th century
By Anthony K. Felts on March 16, 2009
Format: Hardcover
Prof. Shorter provides a fascinating exploration of the psychopharmacology of mood disorders and psychiatry in the 20th century. He describe the early discovery of medications useful in the treatment of the different forms of depression and anxiety (and the general angst of modern life). Some of the most effective treatments were found amongst these early medicines. He describes the ascendancy of the FDA in the 60's and how its flexing of muscles led to the disappearance of some of them based on politics instead of science. Later, the FDA would adopt the policy of approving medications based solely on their ability to outperform placebo. Shorter argues that this has led to weakly effective drugs for mood disorders; he primarily claims that they should be compared to older treatments to see if they are an improvement over the old. (Ideally, a comparison of the new to both placebo and old would be best.)

Prof. Shorter also describes the evolution of the diagnosis of depression with changes in the DSM. He relates how the diagnosis of major depression was more a political consensus to partially placate the psychoanalytic community and less about what was understood about the biological roots of depression. He claims that this new categorization of major depression included the "neurotic" and "melancholic". Making a distinction has implications in treatment.

Prof. Shorter concentrates on the more familiar mood disorder, depression; he does not cover bipolar disorder or schizophrenia. For a history of depression and modern psychiatry, this book is very useful.
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2.0 out of 5 starsSound critc of modern practice, unconvincing advocate for the "good old days"
By Peter C. Dwyer on May 3, 2011
Format: Hardcover Verified Purchase
Prof. Shorter, a well known historian of psychiatry, cites chapter and verse on why the SSRI antidepressants are only marginally effective and probably should not have been approved by the FDA. He quotes damning minutes of internal FDA deliberations about the SSRI's (including astonishing statements by Paul Leber, then-FDA director of new drug approval) confirming Peter Breggin's claims about the ineffectiveness and dangers of SSRI's, the FDA's misleading drug approval process and the pervasive influence of drug industry money on all of it. Prof. Shorter cites scientific, financial and cultural influences he believes make modern psychiatry actually less able to help depressed people than in the 1950's.

This book illustrates bio-psychiatry's history of downplaying its shortcomings until it is convenient to acknowledge them. (Other examples include E. Fuller Torrey's criticism of accepted biological theories in order to advance his own biological take on schizophrenia; drug companies market their products as "safe and effective" until the patents expire, and then reveal the old drugs' problems, touting their "new and improved" drugs that allegedly correct the previously minimized problems).

Prof. Shorter lambasts present day psychiatry, contrasting it with the 1950's and `60's as the hayday of psychiatry. His critique of current practice is persuasive, but his case for psychiatry's good old days is not: he claims amphetamines, MAOI's, benzodiazepines and first generation anti-psychotics were far more effective than most current drugs - but Irving Kirsch's The Emperor's New Drugs, for example, cites meta-analyses showing the old antidepressants' effectiveness virtually identical to today's SSRI's.

Similarly, Prof.Read more ›
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