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Manufacturing Depression by Gary Greenberg

a.      14 hours

b.     Recommended, with some hesitation. I wouldn't totally trust the author's analysis of medical literature, and the author is just a lot more of a sentimental humanist type than I am. But he's looking at this part of the world with his eyes wide open, and it's interesting.

c.      How I chose it: Depression is a huge problem. E.g., it gets tons of DALYs. I wanted to understand it better.

d.     What it is: The author is a clinical psychologist—a Freudian, very literary kind of guy—that's a critic of antidepressants. The book is an interesting mix of informal reviews of studies (largely highlighting evidence for limited effectiveness of antidepressants), history (e.g. about where antidepressants have come from and how depression has come to be seen as a medical condition), personal memoir (e.g. a story about the author's own depression, thoughts on what it

 

30 million Americans are taking anti-depressants, at an annual cost with $10 billion (Chapter 1, 11 min)

 

SSRIs usually fail to outperform placebos in clinical trials. They make a difference in about 60% of people who take them. (Chapter 1, 16 min)

 

Something I found to be annoying rhetoric: "They surely wanted me to feel better, but the real focus wasn't me. I was just the guy they had to go through to get at depression. The carrier pigeon whom they had to treat well while they carefully unwrapped the message from his leg." (Chapter 6, 2 min)

 

The author took ecstasy, and that really helped with his depression and his marriage. (Chapter 8, 10 min)

 

LSD testing. They gave it to therapy patients in lower and higher doses, and found that it had extreme results. Psychotic people didn't like it. They gave it to normal people to see if they became psychotic, and it sort of did, but it wasn't interesting for research. (Ch. 8, 24 min)

 

Methylene blue was a drug that was found to be effective, but off patent. Can't make a drug off of that. People looked for a new drug that relied on methylene blue. (ch 9, 24 min)

 

When antidepressants were discovered, the FDA could only comment on safety. It had to take the doctor's word about efficacy. The agency had 60 days to respond to a drug application, otherwise it was automatically approved. (Ch 10, 25 min)

 

A drug can be approved based on "substantial evidence". E.g., it just needed a couple successful trials, even if a preponderance of evidence suggested that a drug wasn't effective. (Ch 10, 35 min)

 

Independent psychiatrists tend not to agree on what diagnosis a patient has. Talked about a study from a guy named Katz. (Ch. 11, 23 min)

 

If a patient asks for a specific drug when visiting a doctor, they are 3x more likely to get it (can't remember what this is based on). (Ch. 13, 7 min)

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