Action Speaks!, the provocative discussion series at AS220 (115 Empire Street, Providence) continues its current focus on freedom with a look at the introduction of Prozac in 1987 and how it accelerated the tendency to treat mental illness with medication.
The panelists for the discussion will include psychiatrist Peter Kramer, the author of Listening to Prozac, and a faculty member of Brown University Medical School. The dialogue will take place on Wednesday, October 17 from 5 to 7 pm. For more info, visit www.as220.org/actionspeaks.
Kramer took part this week in an e-mail interview with the Phoenix, which is a co-sponsor of Action Speaks.
Are Americans overmedicated, and if so, what are the main consequences?
No one knows the answer to this question. And any thoughtful answer would be segmented. Probably we get too many antibiotics. The underinsured get too little treatment of all sorts. African-American males could get more aggressive medication for hypertension. And so forth.
In the mental health field, and looking specifically at depression, the best studies suggest that Americans are still under-medicated. It used to be said that half of people with depression are not diagnosed, half of those diagnosed are not treated, and half of those treated are not treated adequately. This formula held for both medication and psychotherapy. The data have changed somewhat, but the rule of thumb is not far off.
In this sense, the treatment of depression is a true public health problem. If we took today’s flawed treatments for depression and offered them in their best form to every patient who needs them, we would help more people than if we invented a perfect treatment for depression and gave it only to those who get optimal care now.
What are the most significant changes in the area of psychopharmacology since you published Listening to Prozac?
I thought that within 10 or 15 years, there would be a new medication that would raise comparable ethical issues. I don’t think that one has been developed. Most of the new antidepressants resemble the old ones. The same is true of the anti-psychotics, the stimulants, and the anti-anxiety drugs.
What has changed is our theory and understanding of disease. We know amazing new facts — beginning with the realization that the adult brain makes new neurons and other nervous system cells throughout life. We are much more aware of the harm that depression in particular does. Depression just looks more pathological, in terms of brain and other bodily health than it did 15 years ago.
How will technology change the way that we medicate ourselves, and what do you consider the most serious implications of this?
Too big a question for a quick answer. We would like to be able to work at the level of the vulnerable neuron, so that stress and depression inform the brain without harming it. We would like to use genetics to tailor interventions to persons. Frankly, we’d like better psychotherapies. One of the sad developments in psychiatry is the loss of interest in more daring, less hyper-rational psychotherapies.
Can Americans find a balance between the positive effects of psychopharmacology and overdoing it?
Look, as a culture, we are not big on finding balance. From a European viewpoint, our emphasis on happiness (in the Declaration of Independence, our founding document!) is overdone — and is evident in our working, our spending, and our consuming. My novel Spectacular Happiness follows that theme. That said, I have not seen convincing evidence we overuse prescribed psychotherapeutic medications — nor has anyone else.