Before Prozac: The Troubled History of Mood Disorders in Psychiatry - ISBN:0195368746

Before Prozac: The Troubled History of Mood Disorders in Psychiatry

Date: 15 April 2011, 13:01

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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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