Drug Therapies

Date: The 1950’s forward
Type of psychology: Biological bases of behavior; psychopathology;
psychotherapy
Fields of study: Anxiety disorders; depression; models of abnormality;
nervous system; organic disorders; personality disorders;
schizophrenias; sexual disorders; stress and illness; substance abuse
Psychotropic drugs have revolutionized the treatment of mental illness. Many disorders,
including anxiety, depression, and schizophrenia, may be treated effectively with
these modern drugs. However, the use of psychotropic drugs has created new problems,
both for individuals and for society.

Key concepts

• antianxiety drugs
• antidepressant drugs
• antipsychotics
• mood stabilizers
• neurotransmitters
• psychopharmacology
• psychostimulants
• psychotropic

Based on the rapidly increasing body of chemical knowledge developed during
the late nineteenth century, interest in drug therapy in the early twentieth
century was high. Researchers experimented with insulin, marijuana,
antihistamines, and lithium with varying success. The term“psychopharmacology,”
the study of drugs for the treatment of mental illness, dates to 1920.
Before 1950, no truly effective drug therapies existed for mental illness. Physicians
treated mentally ill patients with a combination of physical restraints,
blood-letting, sedation, starvation, electric shock, and other minimally effective
therapies. They used some drugs for treatment, including alcohol
and opium, primarily to calm agitated patients.

In 1951 French scientist Paul Charpentier synthesized chlorpromazine
(brand name Thorazine) for use in reducing surgical patients’ anxiety and
the prevention of shock during surgery. Physicians noted its calming effect
and began to use it in psychiatry. Previously agitated patients with schizophrenia
not only became calmer, but their thoughts also became less chaotic
and they became less irritable. Chlorpromazine was truly the first effective
psychotropic drug (that is, a drug exerting an effect on the mind) and is
still used today.

The discovery of chlorpromazine ushered in a new era in the treatment
of psychiatric illness. Pharmaceutical companies have developed and introduced
dozens of new psychotropic drugs. Many long-term psychiatric treatment
facilities have closed, and psychiatrists have released the vast majority of their patients into community-based mental health care. Many patients
with mental health problems are treated on an outpatient basis, with brief
hospitalizations for stabilization in some cases. Treatment goals are no longer
simply to sedate patients or to protect themselves and others from harm
but to provide them with significant relief from their symptoms and to help
them function productively in society. As scientific knowledge about the brain
and its function increases, researchers are able to create drugs targeting increasingly
specific areas of the brain, leading to fewer adverse side effects.

This psychotherapeutic drug revolution has had some negative consequences,
however. Drug side effects range from the annoying to the life
threatening. Community mental health treatment centers have not grown
in number or received funding sufficient to meet the needs of all the patients
released from long-termcare facilities. Many mentally ill patients have
fallen through the cracks of community-based care and live on the streets or
in shelters for the homeless. In addition, some physicians and patients have
come to expect a “pill for every ill” and fail to use other, equally or more effective
treatment methodologies. Researchers estimate that 15 percent of
the population of the United States receives a prescription for a psychotropic
drug each year, greatly adding to the nation’s health care costs. The
majority of these prescriptions are written by generalist physicians rather
than by psychiatrists, raising concerns about excessive or inappropriate prescribing.
Some people abuse these drugs, either by taking their medications
in excess of the amount prescribed for them or by obtaining them illicitly.
Studies have shown that prescription drug abuse causes more injuries and
deaths than abuse of all illicit drugs combined. Feminist scholars have
pointed out that physicians tend to prescribe psychotropic drugs more
readily for women than for men.

Despite the negative effects, psychotropic drugs are extremely important
in the provision of health care, not only for those people traditionally
thought of as mentally ill but also for people with chronic pain, serious medical
illness, loss and grief, and those who have experienced traumatic events.