Radical Remedies

spring books

themselves in the original texts. Quite apart inhibitors (MAOI) quickly fell out of favour Y from his scientific skills, Cuvier was also a because of their associated cardiovascular AR

remarkable writer. Eager to convince, he had hazards (the ‘wine-and-cheese’ effect), they O LIBR T

an accurate, clear, elegant style and a great had a major impact as the first effective anti- HO sense of drama that allowed him to draw depressants in the United States. Kline was striking and even sometimes dramatic por- instrumental in lobbying Congress for traits of vanished worlds. funds to support psychopharmacology Throughout this book, Rudwick reveals research and by the mid-1960s he had the interest that can be found in reading the appeared on the cover of Fortune magazine texts written by a man of science whose ideas and had become one of the ten best known 8 JOHN GREIM/SCIENCE P and concepts deeply influenced nineteenth men in America. century society and who helped to raise the The MAOI were soon followed by international status of anatomy and geology amitriptyline, developed by the American as professions. company Merck and like imipramine Philippe Taquet is in the Laboratoire de because it chemically resembled chlor- Paléontologie, Muséum National d’Histoire promazine. The American psychiatrist Naturelle, 8, rue de Buffon, 75005, Paris, France. Frank Ayd, however, had heard about Kuhn’s e-mail: [email protected] results with imipramine and persuaded Merck to do trials in depression, which proved successful. Ayd also published an Superpill: Prozac-takers felt “better than well”. influential book on how to diagnose depres- Radical remedies sion in general psychiatric practice, which The “monoamine era” was heralded by the The Antidepressant Era helped to make amitriptyline the first anti- early discovery that reserpine acted by by David Healey depressant with major sales. depleting monoamine neurotransmitters Harvard University Press: 1998. Pp. 317. The drugs were expanding the diagnostic from the brain. This was followed by the $39.95, £19.98 borders of depression, leading to the under- finding that monoamine oxidase inhibitors Leslie Iversen standing that depression was far commoner and the tricylic antidepressants (imi- than previously thought. This process pramine and amitriptyline) acted by making Over the past 50 years the discovery of drugs reached its ultimate conclusion with Prozac monoamines more available in the brain (by that effectively treat the symptoms of schizo- and the concept that it could make some peo- blocking the degrading enzyme or the tissue phrenia, anxiety and depression has revolu- ple feel “better than well”. reuptake processes respectively). In the tionized treatment and led to radical changes Healey has perceptive insights into the 1960s and 1970s the ‘noradrenaline hypoth- in the way we view mental illnesses. David role of the pharmaceutical industry in the esis’ of depression dominated, although Healey’s book focuses on the discovery and development of the psychopharmacology extensive attempts to provide evidence for development of antidepressants and pro- era, and he portrays the often dramatic rises the underactivity of brain noradrenaline vides a fascinating insight into the history of and falls in the fortunes of individual com- systems predicted by this hypothesis in this field. He skilfully interweaves his panies. He is at his best, though, in describ- depressed patients all failed. Nevertheless, account of the roles played by the key scien- ing the shenanigans let loose by the drug era the hypothesis seemed to gain support from tists and clinicians with the powerful influ- in his own profession, psychiatry. The advent the discovery that new drugs that targeted ence of pharmaceutical companies. of effective drug treatments led to major noradrenaline reuptake (desipramine and The first antidepressants were discov- changes in this branch of medicine — intro- maprotiline) proved clinically effective as ered, by accident, on each side of the Atlantic ducing for the first time the concept of the antidepressants. in the mid-1950s. The Swiss company CIBA controlled clinical trial and ‘evidence-based Twenty years later, however, this idea was tested imipramine in schizophrenia because medicine’. conveniently forgotten as the selective sero- the drug had been designed to resemble in There were often intense clashes between tonin reuptake inhibitors, of which fluoxe- chemical structure the first anti-schizo- different ideologies (defined by Healey as tine (Prozac) is the best known, came to the phrenic agent, chlorpromazine. Although “distinguished by their judgement of what fore. This apparent paradox perhaps reveals imipramine proved ineffective in the treat- ought to be regardless of what actually the naivety of the simplistic monoamine ment of schizophrenia, an astute psychia- exists”). The psychoanalysts who dominat- theories of the 1960s and 1970s, which trist, Roland Kuhn, thought it had euphori- ed the profession in the 1950s and 1960s reached their peak with the notion of one ant or stimulant effects in some of his were pitted against the new biologically monoamine for each major illness: nor- patients and he persuaded the reluctant dominated school who embraced the use of adrenaline for depression, serotonin for company to test it in depression where it the new drugs and called for radical changes anxiety, dopamine for schizophrenia and proved highly successful. in the classification of mental disorders. The acetylcholine for dementia! In the United States, meanwhile, anecdo- two ideologies were often far apart — in The antidepressant era represents one of tal reports that the drug iproniazid had many US psychiatric hospitals the psy- the seminal events in the social and cultural euphoriant effects in some of the tuberculo- chotherapists refused to be associated with history of the latter half of the twentieth cen- sis patients for which it was developed were prescribing drugs for their patients, leaving tury. This book is written in an individual followed up by Nathan Kline, already this distasteful job to the “druggists” and engaging style and the author reveals a famous for his work on reserpine in schizo- employed by hospitals. Eventually there deep knowledge of his subject; he has his phrenia. Kline persuaded Roche to conduct emerged a backlash against the drug era in own firm views but does not force them a trial in withdrawn depressed patients the form of “pharmacological Calvinism” upon the reader. I found it a compelling read which proved highly successful. Kline, a skil- — the belief that drug use is bad or even and hope that it will reach a wide ful publicist, released the story to The New potentially dangerous if it makes you feel audience. York Times and lobbied senior executives at good. Leslie Iversen is in the Department of Roche for continuing support. Although The rise of psychopharmacology as a new Pharmacology, University of Oxford, Oxford OX1 iproniazid and other monoamine oxidase field of research accompanied the drug era. 3QT, UK.