Peter D. Kramer, the psychiatrist and author of the path-breaking 1993 book "Listening to Prozac," said in an interview today that he felt "vindicated" by a newly published study ("Personality Change During Depression Treatment," by Tony Z. Tang et al) finding that selective serotonin reuptake inhibitor (SSRI) antidepressants cause dramatic personality changes in depressed patients who take them.
"It's hard not to feel justified" in the view--offered long before it became fashionable--that antidepressants now taken by 7% of American adults do more than lift depression: They nudge underlying personalities--even those of healthy people--into brighter, more appealing territory, and in so doing, raise ethical concerns about "cosmetic psychiatry."
The study offers evidence that people who are unassertive, pessimistic, prone to worry and prefer to be by themselves or in small groups are more likely to develop depression, and that, when they take SSRIs, those underlying personality traits change more than most peoples' change in an adult lifetime--in the span of 16 weeks. That change in basic outlook not only seems to be the thing that lifts them out of depression; it may even reduce the likelihood that they'll relapse. (You can read our detailed account of the study and its findings here.)
While a group of subjects undergoing cognitive therapy had some of the same effects, they weren't nearly as powerful as those that came from a pill--which in this case was paroxetine, marketed as Paxil.
Kramer found one possible inference from the study particularly striking: that it might turn on its head the view that many clinicians have of the value of drugs and/or cognitive therapy for their patients. "It looks like medicine is good for chronic personality traits and cognitive therapy is good for acute illness," he said. Translation: Maybe any of us who are given to sad or worried rumination should be on SSRIs, and then, if we fall into depression anyway, we can get some time-consuming and expensive cognitive therapy. (That DOES sound like a treatment algorithm that would appeal to insurance companies.)
Not surprisingly, Kramer thought this study might have been funded by the makers of Paxil--GlaxoSmithKline--or some other SSRI. Because in many ways, those companies would seem to benefit from the idea that the medications might be used to prevent depression (creating a much larger market for them), saving more costly measures like psychotherapy for when bad mood, irritability and worry tip into impairment.
In fact, the study was funded by Northwestern University initially, and then continued under a pair of grants from the National Institute of Mental Health.
-- Melissa Healy