One of the best courses I took in college almost 20 years ago had nothing to do with my major or minors. It was "The History of Madness and Mental Illness," taught by Greg Eghigian, now a professor of history and bioethics. Eghigian walked us through changing conceptions of and attitudes toward mental illness, the often horrifying treatments, pop culture portrayals, health care policy, and more. It was foundational to how I think about the intersection of society and medicine and informs much of what I both read and think about mental health. (Today, according to his faculty page, Eghigian also teaches a course called "History of Monsters, Aliens, and the Supernatural," which sounds like a blast.)
That class introduced me to Peter D. Kramer's "Listening to Prozac," which was first published in 1993 and was recently reissued with new material. This week, in what felt like one of those "I've made it" moments, I published an essay in which Kramer reflects on both "Listening to Prozac" and Americans' changing relationship with antidepressants, especially SSRIs. Today, he writes, "We rely on them more but respect them less."
The antidepressants first released in the late '80s felt, for many, almost like miracle drugs: Compared with the medications already on the market, their side effects seemed minimal, their efficacy pronounced.
Now, though, they seem unremarkable, even maligned: Critics bemoan the widespread use of SSRIs, blaming them for many of society's ills. I've taken antidepressants for much of my adult life and am generally happy with them — certainly happier, or at least less depressed, than I would be without them. But I have my complaints. Today I'm on a very low dose of Zoloft, which feels … fine. I am better than I am without it, but certainly not, as Kramer puts it in "Listening to Prozac," "better than well" — a phenomenon he writes about in which SSRIs seemed to help early patients not only recover from depression but seem to be better versions of themselves.
All of this reminds me of the recent "First Opinion Podcast" episode with Michael H. Bernstein on the placebo effect and its counterpart, the nocebo effect. In that conversation, Bernstein noted how depression is one of the conditions that most strongly responds to the placebo effect. Might all of the "better than well" responses Kramer saw in his psychiatry patients in the early '90s have been at least a little tied to the enthusiasm for a new kind of antidepressant? Might my own response to Zoloft be more robust if I were surrounded by people talking it up?
For more on "Listening to Prozac" and how the conversation around antidepressants has changed, subscribe to the "First Opinion Podcast" — soon my conversation with Kramer about his recent piece and the book will be appearing in your feed.
Also on First Opinion this week: The new Letters to the Editor column has debuted, featuring thoughtful feedback on recent First Opinion essays. Three researchers looked into exactly how much ransomware attacks hurt hospital patients. What they found was disturbing. (This piece was published in partnership with the great health care policy podcast "Tradeoffs.") An abortion provider writes about the recent victory for reproductive rights in Ohio — and the changes she still wants to see. (Did you know that abortion providers in Ohio are legally required to share information about Norplant, which was taken from the market in 2002?) Even a former CMS executive has struggled to help a family member navigate the complications of dual Medicare-Medicaid eligibility. Hospital systems have to decide between being Android and Apple. One solution to the health care innovation crisis: patent buyouts. Congress needs to renew a committee that can help seniors during public health crises. And on the "First Opinion Podcast" this week: how school health insurance plans are hurting medical students struggling with mental health.
Recommendation of the week: On Tuesday, the Washington Post published an absolutely wrenching investigation into at-home births gone wrong. While it's a difficult read, I think it's an important one.
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