Rethinking serotonin’s role in mental health

Houston considered himself lucky to have lived the majority of his life without experiencing anxiety. Still, that meant that when his panic attacks started in 2022, it felt like going from zero to 100. Sometimes the attacks would strike at work, leaving him hyperventilating and breathless. Other times they would wake him in the middle of the night, his body in a cold sweat. “I didn’t know what a panic attack was,” says Houston, who spoke to C&EN on the condition of withholding his full name because he fears his mental health history could disqualify him from employment. “To go from nothing to full throttle was crazy.”When Houston went to the emergency room after a panic attack, a doctor asked him whether he had been taking anything that could affect his hormones. About a week prior, Houston had stopped taking finasteride, a hormone-active anti-hair-loss cream. It appeared that what started as an attempt to curb hair loss would become a years-long struggle to get his mental health back to baseline. A significant portion of the US population—including people with drug-induced cases of panic attacks like Houston’s and some of the 2.8 million US adults with treatment-resistant depression—lives with one or more persistent mental health disorders that do not respond to drugs approved by the US Food and Drug Administration. Despite the prevalence of mental illnesses, no one really knows what causes many of them, and relatively few medications have been developed to treat conditions such as anxiety and depression. For