Before the 70s, psychiatric drugs were very risky and were only given to the sickest of patients
Before the 1950s, the psychotropic drug business was small, and the available drugs were terrible. The opiates and the barbiturates were popular with patients but were nonspecific in their effects and caused big-time problems with addiction and overdose. Bromides, paraldehyde, chloral hydrate, and Miltown were all pretty useless and had hard-to-take side effects. By the 1960s, these old medicines had been mostly superseded by the newly discovered and specific wonder drugs in psychiatry—Thorazine for psychosis, lithium for mania, and Elavil and Nardil for depression. But giving these medicines to patients was still a relatively new thing and a big deal.
An overdose of lithium could kill patients or destroy their kidneys, and we were not yet completely sure what were the most effective doses and the safest blood levels. It turned out that the Thorazine doses we were using were way too high and transformed our agitated patients into drugged zombies. The antidepressants available at the time were all extremely risky for use with suicidal outpatients—just a week’s worth of pills could be lethal. And they made life miserable for many of the patients taking them—mouth forever parched, bowel movements few and far between, and fainting on standing up a frequent risk.
Because the medicines could cause arrhythmias, a fancy cardiac workup had to precede their initiation. Nardil required extremely strict dietary precautions because it interacted dangerously with many foods and with red wine—a little blue cheese, fava beans, or Chianti could be deadly. All of the first psychotropic drugs were so risky and unpleasant to take that only the sickest patients received them, and only well-trained psychiatrists felt comfortable prescribing them.
References
- Frances, Allen. (2013). Saving Normal CHAPTER 3. Diagnostic Inflation (p. 124). New York, NY: HarperCollins.
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Type:🔴 Tags: Psychiatry / History Status:☀️