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by William S. Appleton
Plume, 2000
Review by Christian Perring, Ph.D. on Jun 30th 2001

Prozac and the New Antidepressants

This guide to the "new" antidepressants is well written and helpful, and I would recommend it to people who are considering or reconsidering this medication. Unlike other comparable books, it is not filled with anecdotes about patients who have benefited from medication, although there are a few well chosen case examples. Nor are the pages filled with bulleted lists of symptoms of different mental disorders, bulleted lists of side effects, or illustrations and diagrams. Rather the chapters are divided into titled sections with careful explanations of each of the main points. For example, chapter two, "What Are Antidepressants?" has major sections on

  • What Is Improvement?
  • Antidepressant Drugs Available in the United States
  • Heterocyclic Antidepressants
  • Side Effects of Tricyclic Antidepressants
  • Similarities and Differences Among the New and Old Antidepressants
  • The 70 Percent Cure Rate
  • Remaining Problems
  • Treatment Response and Cure
So the format of the book demands that the reader sit down and read a chapter at a time, getting an overview of the facts in context. In the end, this approach will help people more than a book or web page that presents statistics and facts without explaining what they mean.

Appleton is a credible guide to these medications. He points out in his preface that he has never taken a dollar from a pharmaceutical company in speaking honoraria or research support. In a world where the drug industry has such a troubling influence on the medical profession, this is a qualification to be respected. Appleton is ready to be skeptical about the claims made on behalf of these new medications, and he is cautious in he recommendations. He is frank about the common side and withdrawal effects, although he does not go into detail about the rarer more serious problems that can arise with the medication. He explains how if patients react badly to one medication, they may well do better on a different drug.

Although Appleton does discuss non-medication approaches to mental disorders, such as the wide variety of psychotherapies, he does not place much emphasis on them.

Some may feel that he should have done more to highlight the importance of using psychotherapy in conjunction with drug therapy. But it is to Appleton's credit that he is does not resort to the simplistic biological explanations of depression as "chemical imbalances of neurotransmitters." There is a short chapter on herbal medicines which gives some useful information, although it does not really provide information about how to find a reputable supplier with high quality products. As someone who recently has started to try St. John's Wort, I know all too well how confusing when searching through all the different products, with different doses, different forms of the medicine, and stories about variable quality of the different manufacturers. Appleton's book does not help in sorting through those kinds of problems.

There's a final chapter on future medication, which is a little out of place in this book. It does discuss some antidepressants which are available in other countries but not the US, and other ones that are under development. The explanations of their properties are a little too short to be helpful.

Overall this is one of the best available guides to antidepressant medication. It is written on the assumption that people who are considering antidepressants are capable of thinking carefully about their decision, and that they are able to understand some slightly technical terms and scientific data. It avoids larger philosophical and social issues, and maintains its focus on information that will be most useful to patients interested in these prescription medications.

© 2001 Christian Perring. First Serial Rights.