Injections for Depression

In the short dozen years since drug treatment of some mental illnesses was shown to be effective, medical psychiatry (as distinct from the talk-it-out schools) has taken giant strides. Now the pace is so fast that last week Psychiatrist Theodore R. Robie had the temerity to tell a group of critical professional colleagues of a promising treatment that he has been investigating for only five weeks.

Three-in-One. What Dr. Robie was describing to the Society of Biological Psychiatry was a treatment for severe, suicidal depression. And one thing that has become clear as medical treatment of emotional illness has advanced is that progress does not necessarily mean simplicity. Eight years ago, doctors attacked these severe depressions with one drug. Three years ago, they decided they might do better with two. Dr. Robie said he was sending formerly suicidal patients out of his office "jubilant" and "overjoyed" after a complex, three-drug treatment.

Robie's technique is based on time-tested therapy in which patients take daily tablets of "psychic energizer" drugs known to chemists as monoamine oxidase inhibitors. The theory is that in the brains of people suffering from severe depression, the enzyme monoamine oxidase breaks down too much of a group of mysterious brain chemicals called amines, in particular, one known as serotonin. The energizers (there are several on the prescription list, under such trade names as Marplan, Nardil, Niamid, Parnate) are supposed to block the enzyme and thus allow the serotonin to fulfill its normal function.

The trouble is, not all depressed patients respond as well as psychiatrists think they should. It has been suggested that the failures result from an initial shortage of serotonin, and that along with doses of psychic energizers, the thing to do is to supply the brain's metabolic factory with another chemical, 5-HTP, from which it can manufacture more serotonin. This two-drug treatment seemed to work in some cases, but still not as well as expected. Evidently, the reasoning ran, the 5-HTP was not being utilized efficiently.

"Glad to Be Alive." Dr. Alphonse Flora, associated with Ciba Pharmaceutical Co., suggested to Dr. Robie that there might be a way of making the 5-HTP act faster and more effectively by giving yet a third drug. In his East Orange, N.J., practice Dr. Robie tried the three-way method on severely depressed patients, some of whom he had been treating for months or years, keeping them only just short of suicide. The first two or three patients brightened up so much before they got out of his office, that for the first time in years they were glad to be alive.

The treatment is not for any do-it-yourself neurotic. Both the third drug (Dr. Robie uses Ritalin, a Ciba product), and the 5-HTP must be injected, sometimes intravenously, in a series of small doses because they may cause startling changes in blood pressure; one treatment may take two to three hours. There is also the problem that depression has many faces, and Dr. Robie took pains to emphasize that his three-way treatment is not a panacea for all types. It works best in the classical, introspective, melancholic depression, including the depressed phase of manic-depressive psychosis. It works less well, if at all, in the supposedly simpler cases of listless neurasthenia, and on the severe forms of schizophrenic withdrawal.

Among 24 patients suffering from the more responsive types of depression, Dr. Robie reports promising early results in 21.

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