In "The Effect," Allison McCall, left, and Jake Cote are volunteers in a clinical drug trial who fall for each other. (Courtesy Mad Horse Theater Company)
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That special person just walked in the room: Your heart races, your chest and face flush, and you feel an overpowering sensation of warmth, melting, and/or absurd, unaccountable joy. Is it love? Or is it a complex triggering of neurochemicals? 

The question becomes more than academic when Tristan (Jake Cote) and Connie (Allison McCall), volunteers in the clinical trial of a dopamine-enhancing antidepressant, fall for each other. Their infatuation presents big problems for Dr. Lorna James (Amanda Eaton), who runs this month-long in-patient trial, and who has her own concerns about psychotropic drugs, and for her supervisor, Dr. Toby Sealy (Mark Rubin), whose foremost goal is to market them. 

As the experiment progresses and the dosages spike, increasingly tricky questions arise about relationships, mental illness, and pharmacological intervention, in Lucy Prebble’s sharp drama “The Effect, directed by Christine Marshall at Mad Horse. 

Mark Rubin (as Dr. Toby Sealy) and Amanda Eaton (Dr. Lorna James) in “The Effect.” (Courtesy Mad Horse Theatre Company)

Medicine, as a concept and practice, has long straddled the realms of science and spirit, and Mad Horse’s production design makes this liminality immediately visible: The clean white stage, furnished with just two chairs, glazed in a slightly bluish light, and suffused with ambient yoga-class music, might be either mindfully ascetic or institutionally sterile (the on-point scenic, lighting, and sound design are by Caitlin Wold, Christopher DeFilipp, and Scott Leland, respectively). 

And on a raised platform upstage, a smattering of colorful pill bottles, lit with white lights, looks at once like an altar offering and a shiny mess of pharmaceutical discards. 

The rituals of Tristan and Connie’s daily regimen, too, are both clinical and strangely intimate, as they open their mouths for Lorna’s flashlight inspection, as they tell her about changes in their bowels and libido. 

At first, the two young subjects meet all this very differently: Cote’s funny, buoyant Tristan, an affable Southern joker and veteran trial volunteer, downs his first dose without a chaser, then happily drums his hands on his arm-rests. Connie, a watchful psych major, is more skeptical, even troubled; in McCall’s hands, she takes the dose warily, grimaces, and then sinks as if nauseous into her chair. 

But these protocols soon become routine, as Tristan blithely flirts and Connie conscientiously resists. Cote and McCall give their banter a loose, candid appeal that grows convincingly into something closer, and watching their non-verbal reactions to each other is especially affecting. 

In one fine scene, the only language we hear is the pings from their forbidden phones as they exchange nighttime texts; Cote and McCall make beautifully nuanced work of perking up, softening, and smiling not just at the unseen words they read in each message, but at the dopamine-spiking sound itself that announces its arrival. And when Tristan and Connie finally submit fully to whatever it is they share, these performances soar: as the lovers laugh, gaze, poke, play, and sprawl with each other, they positively glow.

Meanwhile, the doctors in charge have their own history, issues, and agendas, which I won’t spoil here. Rubin’s smarmy, Steve-Jobs-lookalike Toby has a shtick where he pulls a brain out of a bucket to ingratiate himself with industry colleagues, calling psychiatry the “Cinderella of medicine.” In Rubin’s capable hands, Toby radiates a kind of breezy pharma-utopianism as he cheerily wheedles and mansplains, and he brings out the sarcasm and resentment in Eaton’s visceral, complex Lorna. 

As cracks first appear in Lorna’s professionalism with her subjects, I’d like to see more dissonance in the early slips, more contrast between the complex personas she’s balancing. But both she and Rubin make fine work of trajectories that open deep grays in their characters, and that show there is no true neutrality in these trials of both a drug and a biophysical philosophy.

The heated arguments that these four characters wage are timely and provocative, though sometimes a bit over-articulated in Prebble’s script, and the actors might do more to modulate them – a little shouting about whether dopamine spikes are the cause or effect of infatuation goes a long way. But elsewhere, Prebble’s dialogue is smart and disarming. 

“It’s like having the weather inside,” a troubled Connie tells Lorna, in a haunting description of her reaction to the drug. And Prebble’s clever plotting puts everyone through their courses with some bracing turns as the dosages and stakes rise. 

“I know the difference between me and the side effect,” insists Tristan, but Connie is increasingly sick with uncertainty, then with what she thinks is certainty. 

But ultimately, certainty is gratifyingly absent here, and Mad Horse’s cast owns and elevates Prebble’s wisely ambiguous final word on these relationships. Is it love, or is it chemicals? Perhaps, after all, the best answer is yes.

Megan Grumbling is a writer, editor, and teacher who lives in Portland. Find her at megangrumbling.com.

“The Effect,” by Lucy Prebble and directed by Christine Louise Marshall, runs through Jan. 26 at Mad Horse Theatre Company in South Portland. Visit madhorse.com.