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Ordinarily Well

The Case for Antidepressants

Peter D. Kramer

Farrar, Straus and Giroux

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ISBN10: 0374536961
ISBN13: 9780374536961


336 Pages



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In Ordinarily Well, the celebrated psychiatrist and author Peter D. Kramer examines the growing controversy about the popular medications. A practicing doctor who trained as a psychotherapist and worked with pioneers in psychopharmacology, Kramer combines moving accounts of his patients’ dilemmas with an eye-opening history of drug research to cast antidepressants in a new light.

Kramer homes in on the moment of clinical decision making: Prescribe or not? What evidence should doctors bring to bear? Using the wide range of reference that readers have come to expect in his books, he traces and critiques the growth of skepticism toward antidepressants. He examines industry-sponsored research, highlighting its shortcomings. He unpacks the “inside baseball” of psychiatry—statistics—and shows how findings can be skewed toward desired conclusions.

Kramer never loses sight of patients. He writes with empathy about his clinical encounters over decades as he weighed treatments, analyzed trial results, and observed medications’ influence on his patients’ symptoms, behavior, careers, families, and quality of life. He updates his prior writing about the nature of depression as a destructive illness and the effect of antidepressants on traits like low self-worth. Crucially, he shows how antidepressants act in practice: less often as miracle cures than as useful, and welcome, tools for helping troubled people achieve an underrated goal—becoming ordinarily well.


Praise for Ordinarily Well

"Dr. Kramer, who has written so well about the curse of melancholia . . . has done something very valuable: He has waded into the contentious debate about the efficacy of antidepressants . . . [Kramer] has done some much-needed synthesizing and debunking . . . his dissections of the most incendiary studies are careful, and his conclusionsthat they overestimate placebo effects and underestimate the potency of antidepressantswill invite a reckoning of some kind . . . his 'interludes' describing his own experience treating patients . . . are beautiful, philosophical, ambivalent . . . Dr. Kramer will no doubt set off a new round of debate with this book. But he stands by his story: Antidepressants help people regain custody of their lives."—Jennifer Senior, The New York Times

"Offers a carefully argued and convincing case that antidepressants not only work but also are an essential tool in the treatment of depression . . . Anybody who wants to hear what Prozac has to say will be interested in this book."—Ann Levin, The Associated Press

"An engaging book about a complex topic, arguing throughout that antidepressants work well and have been given a bum rap . . . Despite the complexity of the topic and the breadth of his research reviews, Dr. Kramer tells the story of antidepressant research in a way that a lay reader can follow . . . The complexities are explained without medical lingo and, in the end, he concludes what psychiatrists see every day: Antidepressants work."—Dinah Miller, Clinical Psychiatry News

"I have always loved Peter Kramer's writing for the reflective way he weds his own practice and personal experiences with extant science to lead us to new and profound insights into the psyche. Listening to Prozac exemplified his ability to define a new paradigm. In Ordinarily Well, he brings a lifetime of treating patients to a consideration of antidepressants, looking carefully at the nature of evidence. The work of one of the few voices out there without ties to industry, this reasoned and beautifully written narrative is another breakthrough, one that brings us to a new and humane understanding of depression and its treatment."—Abraham Verghese, author of Cutting For Stone

"In previous books, Peter Kramer has been an insightful clinician, a sensitive novelist, and a social critic. Here he is a thoughtful teacher. Using both the scientific literature and the lived experience of his own patients, he explains brilliantly the evidence supporting the use of antidepressants. As he notes, depression is a serious, life-threatening illness. Antidepressants work, keeping depression at bay. For some they are not sufficient. And for an unfortunate few, they are not effective. But remembering the hopeless state of treatment only a few decades ago, Kramer reminds us with compelling prose and compassionate insight that today millions of us are much better off with access to these medications."—Thomas R. Insel, M.D, former director, National Institute of Mental Health

"Kramer has done it again. First, he showed the world the potentially transformative efficacy of antidepressants in Listening to Prozac. Now, in Ordinarily Well, Kramer dissects the controversy and misinformation about the effectiveness of antidepressants with impressive clarity and fairness. Kramer is a masterful teacher and clinician who gives readers a rare gift: an insider's understanding of this complex subject, including statistics and the design of clinical trials. Anyone who wants to know the truth about antidepressants should read this book."—Richard A. Friedman, M.D., Professor of Clinical Psychiatry at Weill Cornell Medical College and contributing Op-Ed writer for The New York Times

"In this provocative and personal book, Kramer begins with the premise that he speaks in the voice of 'clinician as sinner.' For Kramer, the clinician's sin is to complicate the simpler story told by the randomized trials, the clerical voice in drug research. He makes the case that the studies need the narrative and the narratives need the studies. We have taken sides in a culture war in psychiatry that we can’t afford. Patients' well-being, indeed their very lives, depend on a declaration of peace. Ordinarily Well makes a compelling case for humility. Sometimes medications work but imperfectly or they work for a while but need to be changed. And sometimes they work when supplemented by the insight that only conversation can provide."—Sherry Turkle, Professor of the Social Studies of Science, MIT, and author of Reclaiming Conversation: The Power of Talk in a Digital Age and Alone Together: Why We Expect More From Technology and Less from Each Other

"For anyone with depression or anyone who loves someone struggling with it, this book is essential. It's cutting edge psychiatry at its best—all the important questions, data, and controversy surrounding antidepressant treatment made crystal clear. Dr. Kramer is one of the rare experts who is, at once, analytically astute, vastly knowledgeable, clinically experienced, and personally very wise."—Sally Satel, M.D., Yale University, and coauthor of Brainwashed: The Seductive Appeal of Mindless Neuroscience

"Biological psychiatry has shown that depression—poetically called 'malignant sadness'—is as biologically 'real' as cancer (or any other disease). This is most apparent when a drug changes the patient's neurochemistry and, with greater than chance frequency, the darkness lifts. Nonetheless, the value of antidepressants has been questioned in both scientific and pseudo-scientific circles. In Ordinarily Well, Peter Kramer, arguably the wisest clinician thinking and writing about depression, emphatically supports the efficacy of using antidepressants in the right place and time. Given the pandemic of malignant sadness that we face, this is a deeply important book."—Robert Sapolsky, professor of biological sciences and of neurological sciences and neurology at Stanford University

"Written with the compassion, verve, and style that are the author's trademark, this book offers an invaluable overview on the state of treatment and the options available."Kirkus Reviews

"Kramer mounts a comprehensive, spirited, and completely convincing defense [of antidepressants], dispelling any doubts about their efficacy and life-changing capability . . . Kramer is at his best when he reflects on the privilege of being a psychiatrist, the value of a doctor’s steady judgement, and the vulnerability of physician and patient alike. He is unwavering: 'Placebos don’t prevent depression, and antidepressants do.' Case closed."—Tony Miksanek, Booklist (starred review)

"Kramer makes an energetic and personal case for the role of antidepressants in easing crippling depression."Publishers Weekly

Reviews from Goodreads


Read an Excerpt


The Birth of the Modern


A SWISS PSYCHIATRIST, Roland Kuhn, invented the modern antidepressant. He didn’t synthesize a chemical. He created the concept.

Kuhn gave...

About the author

Peter D. Kramer

Peter D. Kramer is a psychiatrist, writer, and Brown medical school professor. Among his books are Against Depression, Should You Leave?, and the New York Times bestseller Listening to Prozac. His articles and book reviews have appeared in The New York Times, The Washington Post, Slate, and elsewhere.

Photo by Matthew Kramer