Listening to Prozac, Peter D. Kramer, M.D., Penguin Books, New York, 1993, $12.95

Reviewed by John A. Speyrer

This is more than a book about a very successful anti-depressant. At times, philosophical in tone, Listening To Prozac analyzes the societal implications of Prozac, which appears to be the anti-depressant par excellence. The medication, which has been on the market about seven years, has revealed to both therapist and patient that it does more than alleviate depression. Prozac often makes the patient better than he was before he had his depressive episode.

Many patients believe that Prozac makes them the way they should have always been. It makes them feel that they now know which of their behaviors and personal idiosyncrasies were inborn and which were the result of their early experiences. It is as though the drug performs a temporary "cosmetic psychopharmacology" since it refines one's mental process as the patient becomes more confident and articulate and less bashful and shy. This phenomena of the drug, Dr. Kramer calls "listening to prozac." As a result of his patients' "listenings," the author changed his ideas about basic personality theory. He now accepts that many behaviors which were believed to be inborn are actually "neurotic."

This ability to know certain behaviors as neurotic is something those of us in primal therapy and other deep regressive psychotherapies automatically learned as soon as we began the therapy process. When the unconscious mind becomes conscious during a deep regressive episode, automatic insights often reveal that even some virtues such as perfectionism, tidiness, promptness, ambition, and sensitivity had origins in early childhood and infancy traumas. The author believes that some behaviors need a re-examination in regards to their innateness. He feels that "slight biological derangements" readily yield to the ministrations of Prozac and that the drug not only elevates mood, but also increases emotional resilience. He says Prozac even allows for more depth of feeling, and at the same time uncomfortable feelings, such as guilt, anger, rejection sensitivity, and low self-esteem are triggered less often.

Dr. Kramer claims that Prozac even allows a person to feel his childhood memories of trauma. Unfortunately, other than stating this belief, he does not elaborate about this alleged ability of the drug. Is this a regression therapy in pill form? No, it is not. Prozac does not eliminate the need for psychotherapy, he writes. Dr. Kramer believes that for the treatment of minor depression and anxiety, psychotherapy is best. Medication can interfere with the patient's introspection, analysis, and understanding. He finds the results of Prozac much better if the patient has first undergone extensive psychotherapy and has insights of the origin of his symptoms. He believes it prepares the patient to be well and that Prozac works best on those whose conflicts have been resolved but who still have symptoms.

Listening to Prozac is a complete book on depression (not therapy) and contains interesting information about the history of the development of the various classes of anti-depressants. If you are interested in how anti-depressants work, about dopamine, serotonin, and other neuro-transmitters, you will probably find the information you want in this book. Interesting case studies of the author's various patients and how they reacted to Prozac are included.

A discussion of the possibility that Prozac can trigger violence and suicide is relegated to a short appendix of the book. The author concludes that it does not. Recommended.