Desperately Seeking Serendipity: The Past,Present,and Future of Antidepressant Therapy

Looking back into the “dark ages” of medicine, we can see a fast evolving armamentarium of medications to treat various illnesses, including those afflicting the brain. Up until the past hundred years or so, there has been little in the way of appropriate psychiatric medication therapy. With the discovery of stimulants and opiates, a new door opened into the science of psychopharmaceuticals. Fifty years ago, the greatest leap in psychiatric medicine occurred serendipitously in the form of antipsychotics and antidepressants, some of which we still use today. The learning curve from then has been on a logarithmic scale, and we are quickly approaching the pinnacle of the curve. However, human nature has yet to catch up to scientific progress, as the stigma of mental illness is often reflected in cultural biases and nonparity with insurance benefits for medical care. Because of today’s diminishing medical and psychiatric health care benefits, we strive for superior and quicker acting drugs for these costly illnesses. The best discoveries lay ahead in the 21st century as the potential of Substance P antagonists, antiglucocorticoids, and N-methyl-D-aspartate receptor antagonists (to name a few) are explored for their benefit in depression. Until then, we strive to understand the inner workings of the human mind to heal those with psychiatric illnesses.