[Ordinarily Well] brilliantly dissects decades-worth of antidepressant drug trials, while touting the value of clinical observation and practice ... He argues forcefully that selective serotonin reuptake inhibitors (SSRIs) such as Prozac, as well as other antidepressants, are invaluable tools in the psychiatric arsenal ... It helps that he is a clear, patient and often elegant writer, with a predilection for circling back to his principal points. But his sophisticated argument demands a willingness to grapple with nuances of the construction, interpretation and limitations of drug trials – fascinating, as he predicts, but hardly beach reading.

Kramer is not out to enthrall but rather to re-­engage with an important debate that’s been brewing since the dawn of biological psychiatry: Do antidepressants work? Kramer argues forcefully that they do ... This book would be yet another contribution to the literature of pro- and antidrug jeremiads except that it is so careful and measured and fair, and at times even candidly self-doubting, in its presentation, that it can’t be classified as such ... If you can wade through the statistical and methodological thickets that Kramer, as your Virgil, leads you through in this book, you will most likely come away convinced by his argument for the efficacy of antidepressants — and moved by his humane concern for his patients, and for the needless suffering of unmedicated patients around the world.

A bit of advice before reading Peter D. Kramer’s timely book, Ordinarily Well: The Case for Antidepressants: Skip the preface. There’s too much Peter Kramer in it, and it’s off-putting ... I carp because I care. In Ordinarily Well, Dr. Kramer, who has written so well about the curse of melancholia — that thief who steals your blood and slyly replaces it with lead — has done something very valuable: He has waded into the contentious debate about the efficacy of antidepressants. It’s an important and confusing subject. One in eight Americans rely on these medications, hardly a trivial number. Dr. Kramer shouldn’t risk losing readers so early in the climb with rickety little cairns of humblebrag ... Ordinarily Well can be slow going. While I delight as much as Dr. Kramer does in scrutinizing studies for flaws in design and execution — he talks effect sizes, dropout biases, additivity — his writing is maddeningly turgid in places. But stick with him. He has done some much-needed synthesizing and debunking ... my favorite chapters, by a long chalk, are his 'interludes' describing his own experience treating patients. They are beautiful, philosophical, ambivalent — brimming with all the humility that his opening pages lack.

[Ordinarily Well] takes a unique approach: though at times passionate and personal, it is mostly a detailed excavation of the thorny landscape of the empirical evidence for antidepressant medications ... Kramer, I should be clear, is in no way defensive of Pharma’s dishonesty. Indeed, he describes no financial conflict of interests with the industry, and he disclaims their chicanery in no uncertain terms. It is clear that his support for antidepressants comes from a combination of his clinical experience and his reading of the literature ... Yet, though he offers a host of objections as to why effects in clinical trials unfairly represent what happens in actual clinical practice, one can come up with a variety of counterpoints as to why effects in clinical trials could also inflate real-world effects.

...readers will take pleasure in what is essentially a guided tour through the Aladdin’s Cave of the tools medicine uses to prove or disprove things: randomly controlled trials, meta-analyses and so forth ... Kramer prevents the tour from becoming a forced march by interweaving interludes from his clinical practice with the main exposition of the data ... But there are several problems. Kramer insists that the debate is over the effectiveness of antidepressants, but there is another school of thought that says the real debate is about how many types of depressions there are and how best to treat them ... it is dismaying that, in this supposedly authoritative account of depression and its preferred remedies, Kramer makes almost no mention of the most effective antidepressant of all, indeed the most effective treatment that psychiatry has in its tool kit: electroconvulsive therapy.

...not an easy read, but it is certainly an important one for those who seek help for depression and the providers who treat them ... While examining the ins and outs of clinical research studies, Kramer also takes us on his personal journey as a psychiatrist, beginning in medical school in the 1970s at Harvard, where, at the time, antidepressants were largely discouraged and classical Freudian psychoanalysis remained the predominant mode of treatment ... Kramer effectively explores other limitations of psychiatric research, including the challenges of finding patients for clinical studies and the resulting tendency to include people who are not really depressed in order to meet enrollment quotas ... Kramer could have mentioned the reality that most antidepressants are written by non-psychiatrists whose training in mental health assessment is, unfortunately, often quite limited.