Before Prozac: The Troubled History of Mood Disorders in by Edward Shorter

By Edward Shorter

Psychiatry this day is a barren tundra, writes scientific historian Edward Shorter, the place medicinal drugs that do not paintings are used to regard ailments that do not exist. during this provocative quantity, Shorter illuminates this dismal panorama, in a revealing account of why psychiatry is "losing floor" within the fight to regard depression.
clearly, the publication appears at such culprits because the pharmaceutical undefined, which isn't susceptible to marketplace medications as soon as the patent expires, resulting in the never-ending advent of new--but no longer inevitably better--drugs. however the center of the publication makes a speciality of an unforeseen villain: the FDA, the very employer charged with making sure drug safeguard and effectiveness. Shorter describes how the FDA allows businesses to check new items simply opposed to placebo. in the event you can beat sugar capsules, you get your drug authorized, even if it's truly larger than (or whilst strong as) present medicines, therefore sweeping from the cabinets medicinal drugs which may be more suitable yet have misplaced patent safeguard. The publication additionally examines the FDA's early strength struggles opposed to the drug undefined, an influence-grab that had little to do with technology, and which left barbiturates, opiates, and amphetamines all underprescribed, even though below cautious supervision they're larger at treating melancholy, with fewer negative effects, than the more moderen medications within the Prozac relatives. Shorter additionally castigates academia, exhibiting how types of melancholy, melancholia and nonmelancholia--"as diverse from one another as chalk and cheese"--became squeezed into one doubtful category, significant melancholy, which used to be primarily a political artifact born of educational infighting.
An outstanding and troubling examine smooth psychiatry, Losing Ground is a ebook that's guaranteed to spark controversy for years to come.

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But it is also possible that they will be worse. Actually, it’s sort of a flip of the coin, given that therapeutic safety and efficacy are beside the point in the patent system, where the objective is marketplace exclusivity. In psychopharmacology, the coins have mainly come up tails. In the early 1950s, it was as though someone had opened a faucet. 3 At the Food and Drug Administration, there was discontent. 5 A revolution in psychopharmacology was swamping the system. What were all these new drugs good for?

Then the psychiatrist came across a reference in the literature to codeine, an alkaloid of opium, in the treatment of depression: The pharmacy easily prepared either codeine or placebo in identical capsules. We randomized it and in a double blind 16 before prozac fashion gave her either active drug or placebo for a week or so. Bottom line: after three months the results in this randomized, double blind, n = 1 ABAB design showed highly consistent efficacy with the codeine, as demonstrated by a strong drop in the HAMD [the Hamilton Depression Scale] and some dissociative scale.

Just as psychiatry today has physical treatments for mood disorders, such as electroconvulsive therapy (ECT) and magnetic stimulation therapy, so did the medicine of yore. Convinced that the emotional life of women was dominated by their sexual organs, around 1870 Berlin gynecologist Louis Mayer cured an episode of melancholia involving constant crying in a 57-year-old female patient by applying a pessary: “It relieved her physical problems and many severe disorders of mood. . Previously, a quite inexplicable anxiety had overcome her, sending the most terrible thoughts day and night through her head, giving her no rest, robbing her of sleep, leaving her indifferent toward her children, husband and the entire world.

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