One Step Forward, Two Steps Back: Is psychiatry going backward?

By Richard Handler

July/August 2009

Before Prozac: The Troubled History of Mood Disorders in Psychiatry
Edward Shorter
Oxford University Press. 304 pp. ISBN: 9780195368741

It's now been more than 30 years since the advent of SSRIs like Prozac and its descendants (Zoloft, Luvox, Celexa, Paxil, Lexapro, etc.) triggered what many consider a psychopharmaceutical revolution in psychiatry.
As these medications gained popularity, psychiatry lost its final connections to talk therapy and abandoned the use of an older generation of "ineffective" mood medications. There's only one problem with this widely accepted success story, according to historian Edward Shorter in his new book, Before Prozac: "Most of the antidepressants today don't work very well. That is, in contrast to the 1950s and '60s, when some truly effective medications for mood disorders were available."

Shorter's book is a rip-roaring assault on the practice of modern psychiatry that makes some large claims, the ineffectiveness of the SSRIs not even being the largest. Over the past two decades, he argues, psychiatry actually has gone backward. "Medicine is supposed to make progress, to go forward in scientific terms," he writes, "so that each successive generation knows more and does better than previous generations. But this hasn't occurred by and large in psychiatry, at least not in the diagnosis and treatment of depression and anxiety."

It's Shorter's contention that a…

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