Depression the Growing Role of Drug Therapies

Mental illness can wear many masks. Most are subtler than the deranged face of schizophrenia, but they can be just as paralyzing. Take the case of Dick Cavett. To many TV viewers, the talk-show host and actor seemed to have it all -- wit, charm, fame and fortune. But behind the glib facade, Cavett was falling apart. About 12 years ago, a chronic depression that had haunted him for years rose up and began undermining what he believed was his most valuable asset: his intellect. He became convinced that his brain was "broken" and that life without it was hardly worth living. "Everything seemed to be growing gray," he recalls. "All the things that used to give me pleasure suddenly weren't worth the effort."

Desperate, Cavett checked into a hospital, where for five weeks he was protected from himself while a seemingly mild but potent drug called an MAO inhibitor took effect. Such antidepressants cause subtle changes in the concentrations of certain neurotransmitters, the chemicals that carry electrical messages to and from nerve cells in the brain. The medication, which he still takes on a maintenance dose in conjunction with psychotherapy, worked. His wit, humor and facility for words returned, good as new. And Cavvett came away from the experience with a conviction that his disorder was, as he puts it, "absolutely chemical."

That conviction reflects a growing consensus among scientists that dysfunctions like depression and schizophrenia -- and indeed most mental disorders -- are at their core disruptions of normal brain chemistry and can often be treated as such. The talk-therapy tradition pioneered by Freud and others still has its place. Subconscious issues are believed to affect brain chemistry, and most studies show that drug treatments work best when administered along with some form of talk therapy. But it is the psychopharmacologists, not the psychiatrists, who are making the breakthroughs in mental-health circles.

"There is an explosion of activity," says Richard Wyatt, chief of neuropsychiatry at the National Institute of Mental Health (NIMH) in Bethesda, Md. With computerized scanners, researchers are peering at the chemistry of the working mind. Meanwhile, molecular biologists are beginning to map abnormal behavior to specific strands of dna. And by tracing the action of drugs like clozapine for schizophrenia and Prozac (fluoxetine) for depression, scientists can link moods and feelings to the action of certain chemicals in the brain. The result is a burst of new ideas about how the mind works -- and what is going on when it does not -- unequaled since the days of Freud and Jung.

Advances are being made against virtually every affliction to which the human mind is prey. Generalized anxiety can be treated with surprising success with benzodiazepines like Valium, as well as with a new drug called BuSpar (buspirone). Manic depression was effectively treated with lithium long before anyone knew why it worked; now therapy is being fine-tuned with medications like the anticonvulsant Tegretol (carbamazepine) and drugs that ameliorate lithium's side effects. Debilitating panic attacks can be prevented with both antidepressants and benzodiazepines. Hyperactivity, addictive disorders, phobias, sleep disturbances, even dementia -- all are succumbing to the new science of the brain.