Shepard J. Kantor, M.D.

Both Dr. Scharf and Dr. Cohen give detailed material which I believe adds to the growing literature demonstrating that for some patients medication facilitates rather than precludes productive analytic work (Ostow, 1957, 1961, 1966, submitted; Kantor, 1990). Dr. Cohen's analysand suffered from biological depressions in which she became so profoundly depressed that she would lie on the couch silent, immobilized, and unable to participate in meaningful analytic work. Her silences were not conceptualized as an enactment of transference fantasies but rather as a paralysis induced by a central nervous system disorder which was correctable by antidepressant medication. Dr. Cohen's work shows how, once the depression was remedied, interpretation and analysis of the transference could resume.

Dr. Scharf's patient had recurrent depressions coinciding with the anniversary of his uncle's death. The material he presents shows how once properly medicated, his patient could begin to analyze the significance of these periodic depressions rather than be so overwhelmed by affect that meaningful analytic work became impossible.

Both authors stress the importance of analyzing the patient's fantasies relating to the taking of medication and about the doctor who is prescribing it.

Dr. Cohen's patient wants to know whether she is being given chicken soup or poison, fantasies which can be readily explored and analyzed. Dr. Scharf's patient produced material which could be analyzed, but also engaged in dangerous acting out around the medication which could not be analyzed: Dr. Scharf had to discontinue the monamine oxidase inhibitors (MAOI) because the patient repeatedly sampled foods which were prohibited.

Acting out became an issue with an analytic patient of mine who I was treating with antidepressants. He refused to comply with my suggestion that he obtain an antidepressant blood level which would help me adjust his medication dose. He experienced my request as a demand, as something which