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 "psychopharma-cology," 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-term care 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.

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