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Peter D. Kramer

Peter D. Kramer Biography

Psychiatrist

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“In his work with depression, [Donald] Klein cried to distinguish chose patients who were best created with imipramine from chose best treated with MAOis (monoamine-oxidase inhibitors). Klein found that imipramine was most useful in the treatment of severe depressive episodes with a definite and rapid onset. Patients who looked less depressed, had arrived at depression more gradually, and complained mostly of boredom and apathy did not respond to imipramine but might respond to MAOis. This second group could sometimes be interrupted by distractions or amusements; in the midst of a hospitalization for depression, they might be seen on the ward chatting happily. Yes, they were impaired. But the impairment extended only to appetitive pleasures. Though they had lost the capacity to forage, if pleasure landed on their plate, they consumed it.”

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“In his work with depression, [Donald] Klein tried to distinguish those patients who were best treated with imipramine from those best treated with MAOis (monoamine-oxidase inhibitors). Klein found that imipramine was most useful in the treatment of severe depressive episodes with a definite and rapid onset. Patients who looked less depressed, had arrived at depression more gradually, and complained mostly of boredom and apathy did not respond to imipramine but might respond to MAOis. This second group could sometimes be interrupted by distractions or amusements; in the midst of a hospitalization for depression, they might be seen on the ward chatting happily. Yes, they were impaired. But the impairment extended only to appetitive pleasures. Though they had lost the capacity to forage, if pleasure landed on their plate, they consumed it.”

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“Before studying imipramine, [Donald] Klein had worked with drug addicts, and he noticed that addicts had distinct preferences. Those who favored morphine could generally be distinguished from those who favored cocaine or amphetamine. And though both types of drugs give a rush of pleasure, the eventual effects are different. Opiates satiate an addict, at least while they remain effective. Cocaine and amphetamine do not satiate but, rather, excite further desire; stimulant addicts will tend to "go on a run" and rapidly use all the drug at their disposal. To Klein, these varieties of pharmacologic pleasure-seeking corresponded to varieties of ordinary enjoyment. Some pleasures, like eating a big meal or sexual orgasm, are satiating and do accord with Freud's concept of excitation reduction. But others, like "foraging, hunting, searching, and socializing," or sexual foreplay, are excitatory. Klein labeled these two sorts of pleasure "consummatory" and"appetitive.”

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“For unknown reasons, rare depressed patients even today will respond to no medicine except opiates, and a few researchers into depression have become newly interested in these substances. Fifty years ago, most patients who felt better on opium probably valued it for its ability to ameliorate scattered symptoms, such as sleeplessness, anxiety, and a general sense of malaise. Perhaps for mistaken reasons, Kuhn took the occasional success of opium to set the standard in the search for antidepressants. The hallmark of opium was that it restored energy in the depressed without being inherently energizing. Kuhn set our "to find a drug acting in some specific manner against melancholy that is better than opium"- that is, a nonstimulating antidepressant.”

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