Chlorpromazine: The First Antipsychotic
A story about the importance of cross-discipline communication
Medicines are the first line of treatment for any form of psychotic issues in the modern world. If someone is experiencing extreme forms of mania, hallucinations, or delusions, they are likely to be put on antipsychotics which will help them “calm down”.
But the world wasn’t always like that.
In fact, until the 1950s, psychiatrists had to use unspecified pharmacological agents such as opium or cocaine or rely on electroconvulsive therapy to treat psychotic patients.
The world of psychiatry changed soon though. It changed when the first antipsychotic drug, Chlorpromazine, was discovered.
The Search for a Sedative
The discovery of Chlorpromazine is not a straightforward story. In fact, it is a story that stresses how important it is for professionals to continue cross-discipline communications and be open to learning.
The story begins in a war-torn France during the Second World War. Clinicians at the time were trying to find a sedative that could be used to prevent surgical shock.
A few experts at the time believed that surgical shock occurred due to the excess reaction to stress from the body’s nervous system. The goal, thus, was to find an agent that would reduce the activity of the nervous system before surgery.
Laborit’s Cocktail
Important research in the hunt for this sedative was done by Henri-Marie Laborit, a French neurobiologist.
He created a mixture of different chemicals and found that the ‘cocktail’ he had created was both, a strong sedative and a relaxing agent on people’s nervous system.
He discussed his observations with an Army psychiatrist who agreed that anxious patients woke up from their surgery in a remarkably “calm and stable state”.
Clinicians found that administering the cocktail reduced activity in people without making them lose consciousness. It was termed a form of “pharmacological lobotomy.”
Despite seeing the potential, Laborit did not pursue the psychiatric applications of his ‘cocktail’.
Delay and Deniker’s Tranquilizer
It was the work of Jean Delay and Pierre Deniker that was historic in the creation of the world’s first antipsychotic drug.
Laborit’s cocktail had undergone some modifications and was now called “Laborit’s drug”. Its chemical name? Chlorpromazine
Despite being a known drug, it has not been applied in the field of psychiatry, especially not on psychotic patients.
Delay and Deniker’s work changed that. In doing so, their work also changed psychiatry forever.
In 1952, the two conducted multiple trials and reported resounding success in reducing the positive symptoms of patients with psychosis.
The following case study should drive home how drastic and quick its effects were.
Giovanni A., a 57-year-old manual worker with a long history of mental pathology, admitted for “giving improvised political speeches, getting into fights with strangers and walking along the street with a plant pot on his head proclaiming his love of liberty.” After a 9-day treatment with chlorpromazine, he was able to maintain a normal conversation, and within 3 weeks he was in such a calm state that he was able to be discharged.
- Delay, Deniker and Harl, 1952
Delay and Deniker had now laid the foundations for the field of psychopharmacology.
Across the Atlantic
Across the Atlantic, in the city of Montreal, a young salesman was trying to find takers for his stock. The young man was trying to sell medicines for his manufacturer based out of France.
Naturally, the salesman spent most of his time around doctors. Wherever he went, he would leave a brochure for the products his company made. One of these brochures landed at the home of Dr. Heinz Lehmann, a psychiatrist.
The brochure was in French and Dr. Lehmann was fluent in the language thanks to his wife.
In the brochure, he read about a drug that was being used to calm down psychotic patients in France, a drug called Chlorpromazine. Lehmann was skeptical, but he wanted to give it a go.
In 1953, he conducted the first trial of an antipsychotic drug in North America to control psychomotor excitement in patients. The trial was a resounding success.
The Legacy of Chlorpromazine
While antipsychotics have become a mainstay in psychiatric treatments today, we don’t fully realize how revolutionary they were when first discovered.
Some compare the impact of the discovery of chlorpromazine on psychiatry to the discovery of penicillin in general medicine.
When first introduced, the medicine took the word ‘hopeless’ away from a variety of mental illnesses. It marked the beginning of a new dawn, one where mental suffering could be treated once and for all.
Critics argue that the discovery of the drug led to an infusion of money into psychiatric drugs by pharma companies which led to a profusion of low-quality medicines being prescribed at alarming rates.
Question of the Week!
What do you think about the legacy of chlorpromazine? Do you think it has had a net positive or negative effect on the treatment of psychological disorders?
You can let me know in the comments or by replying to this email :)
Until next time,
Arjun
I had never known about this history. Thank you for sharing. Would love if the story had links to go deeper. I don’t know enough to say what kind of impact it had. What drugs came after?
Good effort, well researched, and shares the need for more investments into drugs for dys-functional psychological experiences. However, it conveniently ignores the need for an eclectic approach. Bio-medical thinking cannot be the only way to hide the symptoms of the patient who reportedly put forward their struggles with the loss of personhood when kept made to depend upon these psychiatric medicines.