Psychiatry's biggest breakthroughs were found by accident
September 29, 2026 · 20 min read
Lithium for bipolar disorder, ketamine for depression and many early treatments were discovered by chance rather than by design, as Deisseroth, Scull and Huberman describe. It explains both the humility the field needs and why new tools like optogenetics matter.
The rules, numbers and steps worth keeping in front of you.
- Core idea: most major psychiatric treatments were found by chance, before anyone knew why they worked.
- Lithium: John Cade used it as a solvent; his lithium-only control showed it was the calming agent.
- Lithium was published in 1949 and approved for mania in 1970; blood levels need close monitoring.
- Antidepressants began as tuberculosis drugs that made patients cheerful.
- The first antipsychotic was an anesthesia aid that calmed patients.
- Ketamine's antidepressant effect surfaced in animal tests that contradicted expectations.
- Karl Deisseroth: no one knows why electroconvulsive therapy works, yet it is extremely effective for treatment-resistant depression.
- Deisseroth: optogenetics can identify the cells behind a symptom and guide more precise drugs.
- Andrew Scull: past treatments built on wrong theories repeatedly claimed 80 percent cures.
- Scull: ask for controlled trials, not striking cases.
- Huberman: little evidence supports a monoamine deficiency, though those drugs help some people.
- Huberman: drugs still require healthy behavior alongside them.
- Poorly understood does not mean ineffective.
- Make treatment decisions with a qualified psychiatrist.
This is the short form. The full insight has every expert's reasoning, their own words and the sources.