Beyond Blue

Beyond Blue


Edward Shorter: Before Prozac–The Troubled History of Mood Disorders

posted by Beyond Blue

I need to preface today’s interview by saying that I whole-heartedly support treatment of depression with the right pharmaceutical medication. For those readers who have just joined us, let me explain that I went through six doctors before I found the right one in Dr. Smith, and I received a lot of bad advice and prescriptions to drugs I could not tolerate. While I am a believer that persons with bipolar disorder and severe mood disorders absolutely should be on medication to treat their illnesses, I am more suspect now than I used to be of physicians who are too dependent on income from pharma companies. That is why I found Edward Shorter’s book so riveting and important. He exposes a piece of the puzzle that I wish I’d known back when I was interviewing shrinks like they were babysitters. Let me make this very clear: I do not believe, as some Scientologists do, that all pharmaceutical companies are part of a conspiracy, and that medication is never the answer. No. I just believe there is a lot of greed in this field, as in all fields. And we need to be aware of the that as we chose our health-care providers.

My mom always says that when you hear something twice that means God is trying to tell you something. So I received this e-mail from my blogging friend Kevin Keough about a podcast he had recorded with Edward Shorter about his book, “Before Prozac: The Troubled History of Mood Disorders in Psychiatry.” An hour later I receive an e-mail from Dr. Shorter’s publicist asking if I’d consider discussing the book on “Beyond Blue.” Coincidence?

I wish I would have read Dr. Shorter’s book four years ago when I suspected that the second psychiatrist I saw was fraternizing with a few too many pharmaceutical reps. In his words, Shorter’s book “exposes why depression runs rampant in America, and why pharma companies, academia, and the FDA are all to blame for setting modern psychiatry back fifty years.”

Thank you very much, Dr. Shorter for answering my questions. I found your book fascinating, indeed!

1. You say that it isn’t implausible for there to be some effective drugs in psychiatry that have simply been forgotten. This is because they are not profitable anymore for the drug companies to produce because the patents have expired. Would you include older drugs like Lithium and some of the Tricylics in this category? Because now many psychiatrists want to treat Bipolar with Atypical Neuroleptics like Seroquel and Zyprexa?

Lithium is one of the most effective drugs in psychiatry, and pharma doesn’t make a dime on it. Therefore, the patent “mood stabilizers” are widely promoted and the dangers of Lithium over-emphasized. Ditto the tricyclics, highly effective for serious depression, but pooh-poohed because of supposedly intolerant side effects (dry mouth, as opposed to such side effects of untreated illness as suicide).

Your question about “bipolar” implies that it’s a separate disease from unipolar depression. But that’s not at all clear. The atypical antipsychotics have been absurdly over-marketed for bipolar disorder. 

2. You write that in the middle third of the twentieth century, the diagnoses did a better job of cutting Nature at the joins than many of the diagnoses we have today, “which are artifacts born of political compromises and sustained by pharmaceutical promotion rather than scientifically accurate descriptions of what is actually wrong with someone.” Can you discuss this a little more and explain some of those diagnoses that were clearer in the mid-twentieth century?

Melancholia was once a common diagnosis, as opposed to such non-melancholic illnesses as “neurasthenia.” These are two very different forms of what would later be collapsed into the diagnosis “major depression.” Major depression is an artifact born of a political compromise within the American Psychiatric Association. There are two depressions, and they are as different as mumps and measles.

Catatonia was once a common diagnosis, later virtually abolished (but nonetheless real). It’s now making a comeback.

The term “nerves” is a pretty good description of the dysphoria many people feel, much better, actually, than “depression.” Nerves has now been broken down into what are doubtlessly small artifactual categories, such as “social anxiety disorder.”

3. You say that the future of today’s psychiatry “does not lie in resurrecting the past but in respecting the scientific method, in abandoning diagnoses fashioned by consensus, and in doing away with ineffective therapies dictated by the corporate bottom line.” Could you try to summarize for my readers what you see as effective therapies … what you say about facing up to the question of evidence, whether a drug is working or not?


The benzodiazepines of the 1960s and after (Librium, Valium) were actually terrific drugs. They became unfairly indicted as “addictive” and are quite effective in non-melancholic mood disorders, such as depressive illness mixed with anxiety, reactive depression, depressive personality, and the rest of what were once called “psychoneuroses.”

The amphetamines were excellent drugs for minor depressive disorders, though not for melancholia, and got patients to feeling better swiftly, as opposed to the long lags that exist today between the onset of treatment and the relief of symptoms.

The barbiturates were formidable sedatives, and had as an achilles heel that they could be accumulated to commit suicide. But there are many ways to commit suicide, and it doesn’t make sense to stigmatize otherwise useful drugs on that ground alone.

Meprobamate (Miltown, Equanil) was the first real anti-anxiety drug, a blockbuster in its day and pushed aside for no better reason than the competition was better promoted.

4. And finally, given all this information, what would be your advice to a reader who is suffering from a mood disorder, wants relief, but is scared to see a doctor and seek treatment because of all this selling out that’s going on?

First of all, all doctors have not sold out [Please let me interject here to say that I know that’s the case. Dr. Smith saved my life. I simply think there are too many doctors today with ties to the pharmaceutical companies, like the man who tried 14 medications on me within three months.], and many are competent diagnosticians who prescribe judiciously. It would be irrational to be afraid of doctors: illness is much worse than the possibility that your physician may have “sold out” because he has a pharma-company pen in his pocket. So, let’s not get carried away.

To answer your question about non-prescription ways of coping with dysphoria:

1) Exercise is actually a great antidepressant, unless you have melancholia. That would be my first choice.

2) Sleeping well at night is usually half the battle, and there are valid nonprescription aids to sleeping better, such as melatonin. Most antihistamines, such as Benadryl, require a RX but they aren’t hard to get and Benadryl (Diphenhydramine) is useful as a hypnotic.

3) This is not everyone’s cup of tea [as a recovering alcholic, I can say he’s right on that!], but many use a good scotch just before bedtime as a sleep aid. It works.

But a note of caution: mood disorders are nothing to fool around with. If you feel you have lost all joy in life, that the future looks bleak, that you have nothing to look forward to, that your life has really been one big failure–and if you have no appetite and are insomniac–you are at risk of suicide. See a physician!

To read more Beyond Blue, go to http://blog.beliefnet.com/beyondblue, and to get to Group Beyond Blue, a support group at Beliefnet Community, click here.

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  • http://knowledgeisnecessity.blogspot.com John McManamy

    Really excellent interview, Therese. Looking forward to reading more interviews.

  • Kevin Keough

    Dr. Shorter is a wise old man who provides exceptionally important information re the history and politics of psychiatry and psychopharmacology. Most will never come across his work because the pharmaceutical industry weilds too much power. Bottom line: it’s naive and foolish to think profits come before people in this industry.
    Much of what Shorter suggests seems to come from the ‘far side’ representing old looney fringe types. Problem is Shorter is ‘too right on’ so he has to be shouted down.
    I believe most readers shake their heads in disbelief as they read that anxiolytics are better than the SSRI’s in treating non-melancholic depression. I can hear collective gasps when people get to use of stimulants and barbituates to treat depression.
    Yes, there are some medicines that are more abusable than others. But let’s face facts: there is nothing simple about tapering off most of the current antidepressants.
    Imagine going into your psychiatrist’s office requesting Xanax or Valium combined with Adderall to treat non-melancholic depression….you’d never live it down. Folks, never underestimate the politics of psychiatry.
    How many people have committed suicide because their depression was too agonizing ? We offer proper pain relief to people suffering from injuries, cancer, etc. How and why is it okay not to offer narcotic analgesics to people tortured by ‘psychological-emotional’pain ? Fortunately, I’ve known a few psychiatrists with the clinical experience and courage to prescribe oxycontin to some patients to keep them alive. The abuse rate is about 3 %. If you are taking too much or don’t need it you get tired and sleepy. If you are in agony you experience something approaching normalcy—-not euphoria. And you are able to function.
    Yeah, this is heresy. It’s worth remembering how quaint or inhumane treatments for depression were 100 years ago.
    Thank God for voices of reason like Dr. Shorter.

  • Therese Borchard

    Thanks, Kevin. Thanks, John!

  • http://community.beliefnet.com/doxieman122 Larry Parker

    It is somewhat reassuring to me in this pharmacorrupted day and age that all four of my drugs are now off-patent.
    Unfortunately, this hasn’t saved me any money with Lamictal/lamotrigine (the one new-generation drug, out of almost 20 I’ve been tried on, that has helped me almost miraculously). But lithium, trazodone (Desyrel) and clonazepam (Klonopin), all pre-Prozac drugs, are an important part of my “cocktail” — and at least their efficacy and side effects (and they do have side effects) are well-known at this point — so I can make my choices without Big Pharma spin.

  • Cully

    “I received a lot of bad advice and prescriptions to drugs I could not tolerate. While I am a believer that persons with bipolar disorder and severe mood disorders absolutely should be on medication to treat their illnesses, I am more suspect now than I used to be of physicians who are too dependent on income from pharma companies.”
    This statement was the hook that caught me… I am dismayed that every illness is treated with one or more medications that will mask the symptoms but (it seems to me) none of the doctors prescribing the medications go on to treat the causes (a psychological wound or genetic predisposition) of the illnesses.
    I wandered around the internet this weekend looking for information – I found plenty of info but no real answer to why drugs (for the rest of your lifetime) are the only answer that doctors have.
    Dr. Shorter’s answer to your second question is a great example of how we are finding new names for old symptoms (depression, nerves, anxiety), and his response to question three, “The amphetamines were excellent drugs for minor depressive disorders, though not for melancholia, and got patients to feeling better swiftly, as opposed to the long lags that exist today between the onset of treatment and the relief of symptoms” brought me out of my chair. Not withstanding that “melancholia” is, by definition, endogenous and “minor depressive disorders” would most likely have an acute or situational cause; it would seem that the “long lag” (as Dr. Shorter calls it) between onset and relief of symptoms results in the disorder becoming chronic.
    If this is true then this situation is criminal, imho. To allow a situation to persist until it has taken a physical route (root) resulting in a chemical change, a physical and mental deterioration in the patient is completely unacceptable. What upset me most is that I could not find any information that addressed Depression as being a condition that people are born with… yes, it may run in families but I didn’t find genetic roots. I did find one article about Bipolar Risk for Kids Born to Older Dads ( http://www.webmd.com/bipolar-disorder/news/20080902/bipolar-risk-for-kids-born-to-older-dads ).
    I don’t know enough to help but what I do know is that this is a dangerous situation, it’s sad and it breaks the hearts of not only the patients but those who love them. I thought Kevin’s post was on point – “Folks, never underestimate the politics of psychiatry.” And Therese’s ‘note of caution”: “But a note of caution: mood disorders are nothing to fool around with.” Amen, Amen!!

  • Kelly

    If you aren’t aware that there is a huge war going on within psychiatry (http://www.nytimes.com/2005/06/14/health/psychology/14ment.html) then you won’t understand Ned Shorter’s take.
    While there is some basis in truth to the claim that pharmaceutical companies don’t make drugs out of the goodness of their heart it can easily be blown out of proportion. They aren’t the only stakeholder’s out there. Don’t let the absence of black hats fool you.
    Psychiatrists in social medicine, behavioral medicine and psychosomatic medicine (Shorter falls into this group) oppose drugs because they make their money from insurance companies and cognitive behavioral therapy – which is therapy designed to convince patients they don’t actually have a disease. Disability insurance only pays for two year instead of a lifetime if they can get an “expert -guess who” to claim the claimant has a psychiatric disorder not a medical disease.
    Their position is in direct contradiction of drug therapy.
    Demonizing Big Pharma and getting the public to buy into their “version” is an easy way to marginalize research and researchers who are on the other side of this war.
    Everyone has an agenda.

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