Psychiatry's biggest breakthroughs were found by accident
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.
What is the insight's main claim about psychiatric treatments? Show answer
Many of the most important ones were discovered by accident, not designed from an understanding of the brain.
How was lithium's effect on mania discovered? Show answer
John Cade used lithium to dissolve uric acid for guinea pig injections, and a control with lithium alone calmed the animals.
How long did lithium take to be approved for mania? Show answer
Cade published in 1949 and FDA approval came in 1970, 21 years later; as a natural element it could not be patented.
Where did the first antidepressants come from? Show answer
They began as tuberculosis drugs that made patients unexpectedly cheerful.
How was the first antipsychotic found? Show answer
Chlorpromazine was tried as an aid to anesthesia, and a surgeon noticed it calmed patients.
Why was ketamine an unlikely antidepressant? Show answer
It is a dissociative anesthetic with a bad reputation, and it blocks receptors thought necessary for recovery, yet animals given it kept swimming longer.
What frustrates Karl Deisseroth about electroconvulsive therapy? Show answer
It works by causing a brain-wide seizure, which is as unspecific as possible, and no one knows why it works.
Why does Deisseroth say psychiatry has relied on accident? Show answer
It lacks a principle for what each brain circuit is for, and diagnosis rests on words with no blood test or scan.
What does optogenetics offer psychiatry? Show answer
It switches specific neuron types on and off with light, showing which cells cause which symptoms so treatments can target them.
What warning does Andrew Scull's history give? Show answer
Confident treatments built on wrong theories, like organ removal, insulin comas and lobotomy, claimed high cure rates and harmed patients.
Where do Scull and Huberman differ on ketamine? Show answer
Scull calls ketamine and psychedelics hyped with weak evidence, while Huberman sees ketamine as an important tool for some people.
Does accidental discovery mean a treatment should be rejected? Show answer
No. Several work well despite being poorly understood, and decisions belong with a qualified psychiatrist.