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Making the First Anti-Depressant: Amphetamine in American Medicine, 1929-1950
- Journal of the History of Medicine and Allied Sciences
- Oxford University Press
- Volume 61, Number 3, July 2006
- pp. 288-323
- Article
- Additional Information
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Journal of the History of Medicine and Allied Sciences 61.3 (2006) 288-323
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Making the First Anti-Depressant:
Amphetamine in American Medicine, 1929–1950
Nicolas Rasmussen*
We are accustomed to thinking of the widespread use of anti-depressant drugs as a recent phenomenon, and one of decidedly mixed blessings. While no doubt effective, their phenomenal popularity since the 1990s has raised questions about the medicalization of problems of living and the fading boundaries between healing and medical enhancement (or the specter of "cosmetic pharmacology," in Peter Kramer's pithy formulation). Today's anti-depressants have also, for some critics, come to symbolize the excessive influence of the pharmaceutical industry over the definition and treatment of illness. Drug companies are said to reshape, or even invent, disorders to fit the drugs they are marketing, manipulating medical knowledge like never before—and particularly in the area of mental health. The historical narrative that often underpins such critiques places the beginnings of psychiatric medicine's loss of control over pharmaceuticals around 1960, when the monoamine oxidase inhibitors and (especially) the tricyclic anti-depressants first entered the market. A variant narrative suggests that, instead, it was [End Page 288] Miltown and the other minor tranquilizers that ushered in widespread pharmaceutical influence over psychiatric thinking and practice, during the second half of the 1950s.1 In either account, society today is portrayed as overmedicated for depression and other functional psychiatric disorders because the boundaries of illness have been overstretched by drug company marketing, and sound professional judgment no longer governs prescribing.
This article will argue that such accounts abbreviate and oversimplify the longstanding and complex interplay between psychiatry and the drug industry. In particular, they ignore an earlier period, beginning in the late 1930s, when amphetamine was widely used as a specific therapy for neurotic depression. Here I attempt to recover this forgotten early chapter, in order to show that amphetamine represents the first of the anti-depressant drugs, even though it was invented for another purpose and is no longer regarded as an anti-depressant. Indeed, the introduction of amphetamine to psychiatry in the 1930s and 1940s played a key role in reshaping medical understanding and practice, along with popular expectations, to create a society of psychiatric outpatients routinely consuming mood-altering drugs en masse. That is, amphetamine established the need—the market—for anti-depressants that a succession of later drugs, including the currently dominant selective serotonin reuptake inhibitors (SSRIs, e.g., Prozac), have filled since. Furthermore, medical thinking about depression and its treatment appears to have been influenced by the drug industry, in this earlier period, in much the same manner that it is said to have been influenced in later years.2 Thus, the story of amphetamine's [End Page 289] development as an anti-depressant opens large questions about the ways we think about both the history of pharmaceuticals and the history of depression.
The Historiography of Psychiatry and the Psychiatric Medicine of Interwar America
Unfortunately, the standard historiography of psychiatry presents major obstacles to interpreting the story at hand and therefore must be addressed at the outset. According to the current standard narrative, biological psychiatry in the 1960s was a new and revolutionary force that by the end of the next decade had overthrown a thoroughly psychoanalytic establishment, in place since before World War II. Before this "biological revolution," psychoanalysis and other "dynamic," talking approaches had little to do with psychiatry as practiced in mental institutions. Freudian therapists believed that most if not all mental illness could be healed through insight into the distressing early experiences that had caused it. Thus they eschewed the use of drugs for all but the most hopeless psychoses, just as they scorned lobotomy and electroshock and other biological therapies; outpatients being treated for neurotic conditions largely shared the same aversion to drugs. For their part, the institutional psychiatrists were more biologically inclined in their approaches to their seriously ill inpatients, but they saw drugs as nothing more than sedatives and instruments of restraint (at...