L’Institut universitaire en santé mentale de Québec – Psychopharmacology

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Psychopharmacology, which has been around for a long time, only really developed recently and, with its quite phenomenal ability to control mental illness, effectively puts the medical treatments in vogue in the mid-20th century on the scrapheap. With its diversity and multiple areas of action, it is a major element in the development of treatments for mental illnesses and changes our perceptions. As soon as mental illness began to be treated like any physical illness – with medication – the public at large became more tolerant of people with mental illness.Sedatives and hypnotics used to treat mental disorders were put on the market towards the end of the 19th century in Germany. Morphine, a derivative of opium, was discovered as early as 1806. Opium was often prescribed at that time for its tranquilizing, sedative properties. However, it was abandoned in the late 19th century because patients became addicted. Bromides, calming medications used to treat nervous disorders and insomnia, were discovered in 1826, but were only used in asylums towards 1880, for their sedative properties, to relieve addiction to morphine and cocaine, and to calm agitated patients so that they did not exhaust themselves. They brought about a prolonged sleep cure for very excited patients. Bromides were used up to the 20th century.1Chloral hydrate, discovered in 1832, began to be used in psychiatric hospitals in 1869. This medication was very popular for a long time because of its soporific properties. Scopolamine, or hyoscine, was discovered around 1880 and used as late as 1950 to calm patients with anxiety. In 1903, barbiturates, strong sleeping drugs, made their appearance. Since then, approximately fifty derivatives have been put on the market.2 Meprobamate, a chemical tranquilizer, was the first to become wildly popular, to the point that in 1956, one American in 20 used it. But its harmful effects were discovered and it was scrapped.3Psychopharmacology was developing more and more in the 1940s. The same medications were used, but some, like hyoscine and morphine, were combined to achieve better results. Because of the overcrowding in psychiatric hospitals at the time, it is understandable that arguments among patients and noise were common. The development of psychopharmacology brought calm to the crowded wings.4 But true modern psychopharmacology began in the 1950s with the arrival of antidepressants and neuroleptics, whose antipsychotic effects were discovered by Jean Delay (1907-1987) and Pierre Deniker (1917-1998). Among antidepressants, chlorpromazine (Largactil), used mainly in the 1960s in the “Laborit cocktail” (a mixture of Demerol, Phenargan and Largactil), revolutionized psychopharmacology by calming agitated, excited patients. Largactil was the first truly effective medication for psychoses. It was used a great deal at that time. In 1953, in Hôpital Saint-Michel-Archange alone, 230 patients were treated with this medication. Neuroleptics were also active on patients’ agitation and on psychoses. Great hope was put in these medications and results were promising. They were also used to control disordered thoughts, affect and behaviour.5 Since the discovery of all these medications, a whole array of antidepressants and antipsychotics has been put on the market, replacing all other treatments used in the history of madness since doctors began to search for a medical solution to this problem.The 1960s also saw the marketing of new products that would revolutionize psychopharmacology: benzodiazepines, which are still used today. They replaced the barbiturates discovered some decades earlier. Recognized for their anxiety relieving and hypnotic properties, they would become the most prescribed medications around the world. The best known control anxiety: diazepam (Valium), flurazepam (Dalmane), alprazolam (Xanax) and lorazepam (Ativan). Lithium was also discovered at this time (1954) by Mogen Chou, and was used to treat bipolar disease. In 1987, fluoxetine (Prozac) appeared. Still very popular today, it is used to treat anxiety, depression, bulimia, obsessions, panic and malaise.6The arrival on the market of all these medications greatly changed the treatment of mental illnesses. A revolution in the science of psychiatry and a new conception of mental illness followed. The new wave advocated deinstitutionalization, which was to take place en masse in the following years, so that today we have treatment provided in the community and much more extensive research at the Institut universitaire en santé mentale de Québec.In the 21st century, new debates are arising regarding ethics and the law. Specialists today question the administration of medications: Should we give a medication to a patient who cannot understand the importance of side effects? In the same vein: Can a person who is completely removed from reality truly make an intelligent choice that has been well considered and will be beneficial for him or her? Many people are pondering these issues today because the invention and administration of medications continues to bring up questions of this kind. (D1-D3-D4-D5)

1. Lambert Tremblay. op.cit.,p. 25.
2. Ibid., p. 26
3. Hubert A. Wallot. op.cit. p. 126.
4. Jules Lambert. Mille Fenêtres, op.cit., p. 81.
5. Ibid., p. 74.
6. Lambert Tremblay. op.cit.,p. 34.