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January 15, 2003. Richard Gottlieb is to be congratulated for his attempt to understand the efficacy of SSRI medication in psychoanalytic terms. The editors of JAPA are similarly to be recognized for their willingness to further the dialogue between psychoanalysis and psychopharmacology.
That said, I should like to record a few difficulties I have with Gottlieb's thesis. He proposes that SSRIs are effective for the treatment of depression and some other conditions because, by whatever neurochemical mechanism, they attenuate or remove aggression. His evidence consists of the common clinical observation that when depression, obsessive-compulsive neurosis, or some cases of social anxiety are treated with SSRIs, the aggression disappears as the patient recovers.
The trouble I have with his argument is primarily that the relation between SSRIs and the removal of aggression is not specific. Any