The Profound Influence of Today’s Antidepressants

Today’s Video: Can Antidepressants Change Our Personalities?

Rich Simon

For decades, our field has debated the effectiveness of antidepressants in therapy: how much of recovery comes from the placebo effect? Do SSRIs help people achieve anything more than basic levels of functioning? Do they even work at all?

Caption: Peter Kramer on the profound effect antidepressants can have on personality.

This contentious issue isn’t likely to die down anytime soon. But according to Peter Kramer, author of the acclaimed Listening to Prozac, there’s solid evidence that some antidepressants have the capacity to not only help clients beat depression, but come away from it with more robust personalities than they had before.

In this brief video clip, Peter explains how newer antidepressants like Paxil and Prozac not only did away with side effects found in their older counterparts, but seemed to give people a competitive social edge. “There’s been controversy over whether these medicines work,” says Peter. “But the research seems to show that when people take them, something happens to personality.”

In the Networker Webcast series Meds: Myths and Realities, Peter shines a light on the controversial notion that today’s antidepressants can fundamentally change the way people think and behave.

Tags: antidepressants | depression | prozac | ssris | therapy

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Monday, August 11, 2014 12:31:57 AM | posted by Carola Hundrich-Sour
for resources in neurofeedback, look at under resources.

Monday, August 11, 2014 12:30:40 AM | posted by Carola Hundrich-Sour
Interesting discussion, here are a couple of thoughts: 1.) regarding the effectiveness of antidepressants, see boos like "making of an epidemic", or "Pharmageddon" by David Healy, a very well respected psychiatrist in Britain. He also has a website that tracks reactions to medication. Anyone can fill out an on-line form and get a free report with respect to the interactions of medications.
2.) With respect to questioning the serotonin hypothesis of depression and why anti-depression are supposed to work: please read in the chapter on depression in the DSM V on the causes for depression (spoiler alert: lack of serotonin is not listed as a reason for depression).
3.) There are many other intervention that may address depression on a physiological basis, for example see "the Breakthrough depression solution" by Greenblatt.
4. ) consider an intervention like Neurofeedback or EEG biofeedback--resources are listed at the website. There have been several studies supporting the use of neurofeedback, also consider transcranial stimulation. Neurofeedback for ADD has now the highest research support based on the American Pediatric Association; depression does not show that many studies that the ones we have, are very strong.
A broader way to conceptualize depression may benefit us and our clients.

Thursday, August 7, 2014 5:11:24 PM | posted by Cliff
Hey, Jeanne. Kramer is referring to Prozac and Paxil as "newer" at the time of their initial appearance.

I interviewed Peter Kramer for an article when his book came out over 20 years ago. I had begun taking Prozac myself at that time. My experience was exactly what he describes in his book as "cosmetic" effects. Not only did my depression lift, but I suddenly became very extroverted and the most productive I'd ever been. I'm talking a profound change. I even remember the exact moment it "kicked in."

However, the drug lost its profound effectiveness after a few years. What did remain for quite a while was the capacity to interrupt my rumination. The drug somehow taught me how to clear the space for me to step back and observe my thoughts (much as occurs in mindfulness training and CBT).

But that diminished too. I tried other drugs, hoping to restore Prozac's full effects. Paxil was the first -- a drug I will not allow my consulting psychiatrist to prescribe to my clients. It literally took me a year to fully withdraw from it. My depression has not really responded to any other antidepressants, even taking several at a time and adding drugs like Abilify to the cocktail. My psychiatrist wants me to consider ECT, but I'm very reluctant.

Several people here mention the placebo effect as being equal to that of the antidepressants themselves. That is true in mild depression. In early episodes of major depression, they apparently have a more measurable effect . But they have really not been of any help to me in well over a decade. My depression is its worst ever now.

There has been a huge amount written about these drugs in recent years, including, of course, the revelations that pharmaceutical companies suppressed the evidence of the drugs' relative ineffectiveness with mild depression. The notion that depression is the result of certain biochemical processes involving, serotonin for example, is also being questioned.

What is finally getting some attention is the effects of culture on mental health. When one's circumstances are dire, depression is just about inevitable. We live in a society that now has a larger income gap than during the gilded age, countless people have lost a sense of agency, and our elected representatives continue to punch holes in the safety net. Of what value is an antidepressant to the average person who really does face such a bleak existence. There have even been studies -- one by the UN that enraged the APA -- that demonstrate higher recovery rates in societies that do not widely prescribe antidepressants. The APA insisted the UN repeat the study. They did. Same results.

Sorry to go on and on, but, as a therapist and a person who has dealt with depression himself for 30-plus years, I know very well that these drugs have very limited effectiveness and, according to a growing body of research, may do more harm than good.

Thursday, August 7, 2014 6:01:07 AM | posted by Claudette Wassil
I am both a professional in the field of psychology and a person with a mood disorder. I have absolutely no doubt that antidepressants work. They have saved my life, both literally and figuratively. I'm sure I would have committed suicide 30 years ago if I had not been given antidepressants. Barring that, I couldn't regulate my mood well enough to hold down a good job prior to taking antidepressants.

I had therapy without antidepressants for 20 year before I started medication. It was still a relatively new therapy and no one had suggested it to me until my son was in crisis and needed antidepressants. I saw what they did for him and I wondered what they could do for me.

After 20 years of therapy I still had mood swings that seriously interfered with my functioning and made me question if I wanted to go on living like that. I would have months or years where I was OK and my self-esteem was very high. Then a biochemical change would take place and I would find I couldn't follow through and do what I'd committed to do. I couldn't speak in public; I couldn't show up to chair meetings; I couldn't get out of my bed to clean my house. Everyone would be disappointed in me, even angry, and my self-esteem would plummet. I did not want to live if everyday I was a disappointment to everyone around me. That's a pretty understandable reaction in one who was a leader admired by all who suddenly becomes totally incompetent.

After two month of taking antidepressants, I no longer needed therapy. There was simply nothing to talk about. I have sought brief therapy off and on when I have been in crisis since. But I will never need prolonged weekly therapy again.

Any therapist who believes that antidepressants work mainly as a placebo effect, and can never replace therapy, is just flattering themselves.

Thursday, August 7, 2014 1:58:41 AM | posted by Jeanne Gilchrest
I'm surprised to hear Paxil and Prozac described as "newer" antidepressants. Really? Peter Kramer's book was thought provoking when it was first released in but it's less about personality and more a message against medication. The rerelease adds the "newer" medications but is still more about the bad things drugs do instead of the effects on personality.

From Merriam Webster: personality: a : the quality or state of being a person

Theories of personality have become both more fluid and more complex in the last 2 decades. This course, at least in the way Networker has described, seems terribly outdated.

Wednesday, August 6, 2014 10:44:08 PM | posted by daisy swadesh
When are we going to do systematic studies on the placebo effect--how what we think and believe affects our ability to get well?
Of course this presents extraordinary difficulties--but consider how most doctors expect their patients to trust them and to believe they can get well through what the doctor prescribes. Doctors ASSUME the placebo effect as a part of healing.

Wednesday, August 6, 2014 10:02:49 PM | posted by Sarah Irons
I'm a little shocked to see the suggestion that SSRIs and other meds might "improve" people, and horrified by the assertion that "newer antidepressants like Paxil and Prozac did away with side effects found in their older counterparts". Come on. While I have occasionally seen people really improve their functioning while on meds, I have way more often seen the negative fall-out. These drugs have PLENTY of effects (calling them side-effects only serves to minimize them) and often not intended ones. And while some people can use them for a time and then withdraw with no problems, many people have a terrible time with debilitating withdrawal symptoms.

Whenever possible, I believe we should support people to find drug-free ways to resolve their difficulties. (Though to be clear, I never impose my beliefs about meds on my clients, and never express judgment if they choose them or find them helpful.) The risks are significant and not to be minimized.

Wednesday, August 6, 2014 3:01:08 PM | posted by Don Acorn
Not nonsense at all. My own experience with Prozac showed me that I was functioning better than I ever did in several areas of my life. After 4 years it pooped out, but when it worked it helped in ways I never expected. Like most psychotropics, they work for some of us some of the time but none of us all of the time.

Wednesday, August 6, 2014 2:46:28 PM | posted by Lynn Johnson
This is nonsense, of course. There is a very small effect from antidepressants, and a large placebo effect. Of course there is some effect on personality, as there is with changing eating habits, instituting exercise, getting more involved with community groups, and so on. Personality is constantly shifting and adapting to the changes.

But how does Dr Kramer tease out the placebo effect?

As a therapist I have seen much less impact from the SSRIs than Kramer seems to find.