Bonding by Mariel Franklin

Author:Mariel Franklin
Language: eng
Format: epub
Publisher: Macmillan
Published: 2024-06-27T00:00:00+00:00

22

‘It’s been almost fifty years since the monoamine hypothesis was conceived.’ Grace had opened the window in her kitchen. It was Saturday morning, Niall and Evie had gone out and she’d invited Tom and I for coffee, which I quickly realized was actually a debrief on their new gig. It was hard to concentrate on what she was saying.

She stopped mid-sentence. ‘I hope you’re listening. Is this what you two are going to be like now?’

She lit a cigarette and waited patiently until she had our attention. ‘So, the monoamine hypothesis proposed that low levels of serotonin, norepinephrine and dopamine were indicators of depression, usually in the form of feelings of low status in dominance hierarchies.’

‘We already know this,’ Tom said.

‘I know, and we’re going over it again.’

He raised an eyebrow at me apologetically.

‘So,’ she continued patiently, ‘the theory was that artificially increasing these chemicals would alleviate depressive symptoms. The initial treatments were discovered by accident when Hoffmann-La Roche were trying to treat tuberculosis. That was when they first noticed that iproniazid was giving their patients feelings of euphoria.’

‘The first antidepressant,’ Tom said, as if to make the point that he didn’t need the lecture.

‘Exactly. Although it was only used off-label. It took another decade for the first branded treatment to come out. Tofranil wasn’t released until the late 1950s. That established a new class – tricyclics.’

I felt his hand slide across my knee.

‘You seem to be finding it difficult to concentrate,’ Grace said. ‘You know I’m going to test you on this later?’

She was quite convincing at cracking the whip.

‘So,’ she persisted, tapping her cigarette on the window ledge, ‘the main issue with depression is that it’s badly defined. As far as we know, the causes are spread across several different factors: genetic, environmental and psychological. There isn’t even a lab test for it.’

‘Everyone knows what it feels like, though,’ I said.

I felt the need to at least pretend that I was interested in what she was talking about.

‘To some extent. The idea of melancholia, for example, has an ancient history. It goes back to the Greeks. But our relationship with it has always been opaque, to say the least. Even today, our classifications are pretty vague. Patients are supposed to show at least five of eight possible symptoms: sadness, loss of pleasure, insomnia, tiredness, feelings of worthlessness, poor concentration, agitation and suicidal thoughts.’

‘Sounds like an average day at the office.’

‘Exactly. Which is why the biomedical model is contentious. If you look at research from the 1990s when this approach was first entrenched, it’s all very loose and abstract. The results never pointed in one direction. The idea that depression can be treated with a pill – that it’s just a chemical imbalance – a lot of that stuff was oversold. It was all marketing copy. It was storytelling, really. Which is where we come in.’

She reached over to the kitchen counter and picked up a box of pills.

‘The product,’ she said, cradling it in her hand. ‘So, let’s run through its USPs: firstly, this is a drug that doesn’t have the usual side effects.

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