It would be great if there was a pill that you could take to cure mental disorders. I mean, sure, I take like, 6.5 pills every day to make my brain behave in a way that approximates regularity, but I have to do that every single rotation of the earth probably until my corpse is left in the woods for wolves to feast upon. That’s not a cure! That’s a treatment! And it’s a pretty big deal, considering our relatives 100 years ago had no such treatment. They were just all playing life on Hard Mode, no water wings, no bumpers, and no Plan B. PASS.
In fact, the idea that a pill could do literally anything to address mental illness was pretty far-fetched until like, just a couple of generations ago. That’s because a.) ~the mind~ was viewed as its own special spooky realm and 2.) there was already an assumption that anything which impacted the mind was probably based in something physical anyway so like, let’s just pull your teeth out and hope for the best!
So it was a little shocking when patients on the tuberculosis ward suddenly began cheering up with little to no prompting. One minute, they were lying in their starched white beds near an open window, prone and sullen, and the next they were GIDDY. What could possibly go wrong?
Don’t worry. Things did go wrong.
“Dancing in the halls tho' they had holes in their lungs”
Located in Staten Island, the Sea View Hospital Rehabilitation Center and Home was a respected location for TB patients to go and, well, probably die. Because for many years, the only cures for TB were fresh air and waiting hopefully. Doctors were trying all kinds of things, some of which were more effective than others, when Dr. Edward H. Robitzek began giving his patients a new potential treatment called isoniazid.
Newly-isolated and relatively unknown, isoniazid was one of those drugs that I suspect the medical industry was like “yeah, sure, let’s see what this does.” You know, like how viagra was made for heart conditions. Or that time some cheese-headed clown thought a good way to sterilize people with uteruses was to put tiny springs up into their Fallopian tubes and wait for their bodies to fight desperately to expel them. Medicine! It’s fun.
Anyway, isoniazid is an antibiotic, which was already kind of the route most doctors were taking to treat TB, so it made sense. Sea View patients were the first in the nation to try it and they were so happy with the results! And, seemingly, everything else. An AP report that I’ve seen cited several times quoted one orderly as saying the patients were “dancing in the halls tho' they had holes in their lungs.”
The TB patients, who were usually pretty morose for multiple reasons, were suddenly up and about. Many had been in the hospital for months or even years, and might have been told that their case was incurable. It was a depressing place. Until, suddenly, it wasn’t.
Surely, this meant that they were cured, right?
Not so much. It turns out that the drug is also a non-selective, irreversible monoamine oxidase inhibitor (MAOI), which means they change the brain chemistry. Just like my beloved SSRI helps the little messages in my brain land where they need to, an MAOI can ease depression and its symptoms. And boy did it!
And so, the first antidepressant was born.
Well, sort of. There were a couple of other drugs also being kicked around at the same time. But isoniazid had an advantage in that it was already proving itself to be effective and getting press for doing so. Doctors did some kind of doctoral magic (I am not a doctor) and converted the drug to a new formula called iproniazid, which is also an MAOI, and began researching. And anyway, at first the researchers just thought this drug was really good at curing TB and that’s why everyone was so excited!
Life magazine even sent a team to capture the happy patients and staff.
They were not only experiencing (honestly, nominal) relief from TB, they were experiencing relief. From like, everything. Reporters at the time stated that the mood was “bright last week with the happy faces of men and women.”
But, like pretty much all drugs, there were some long-term effects that weren’t super-clear at the beginning. And also, while people were feeling better, they weren’t necessarily getting better. A lot of patients were still experiencing lung issues. But they sure were cheerful! So the researchers pivoted. And people took notice.
A 1957 New York Times article touted the discovery, stating “a side effect of an anti-tuberculosis drug may have led the way to chemical therapy for the unreachable, severely depressed mental patient.” According to the Times, “its developers call it an energizer as opposed to a tranquilizer drug.”
And indeed, it energized many! The first round of trials saw that most of the patients - I’ve seen numbers up to 70% - felt happier and more alive.
After some study, the drug began to gain traction in doctor’s offices. For a couple of years - really like, two - iproniazid was prescribed for depression around the country. The glimmer faded quickly, though, when patient’s livers began to fail en masse.
Iproniazid’s reign may have been brief, but it really was important. Within its development was an answer to a long-sought question: Is it possible to treat the brain the same way we treat the body?
Other antidepressants had begun to appear on the market at this time and before too long, all of the known happy pills you’ve heard of became available. My beloved lithium, for example, came to the market in 1970.
Really, what this story tells me that medicine is mostly a game of lucky breaks and humans used as test subjects. But I mean, lucky for all of us, I guess?