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Mental Illness and Neurotransmitters:
Psychopharmacology and the Prozac Era
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“The Society of Biological Psychiatry was founded in l945 to encourage the study of the biological causes of and treatments for psychiatric disorders. Its continuing purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms, and treatments of disorders of thought, emotion, or behavior.”
Journal founded in 1969
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Contributing Factors to Rise ofBiological Psychiatry
• Renewed attention to needs of the psychotic in mental hospitals
• Genetic Studies (Kety, 1968): almost 10% higher incidence of disease in relatives of schizophrenics as compared to controls
• Rise of controlled clinical trials as the gold standard in medicine; importance of “criteria, control, and variables;” talk therapies didn’t measure up
• Development of psychopharmaceuticals• New journal: Biological Psychiatry (1969)
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Santiago Ramón y Cajal (1852-1934)
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Cajal Drawingof
Purkinje Cells from
Pigeon Cerebellum
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Cajal’s Anatomical Drawings
Axon-conducts impulse
Dendrite-receives
impulses from other neurons
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Ramon y Cajal’s drawing of a human motor cortex pyramidal cell as tattoo!
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Otto Loewi’s (1873-1961) Experiment
with Frog Hearts
Electrical stimulation of the vagus nerve (attached to heart #1) caused heart #1 to slow down. After a delay, heart #2 also slowed down. Loewi hypothesized that electrical stimulation of the vagus nerve released a chemical into the fluid of chamber #1 thatflowed into chamber #2. He called this chemical "Vagusstoff". We know this chemical as the neurotransmitter acetylcholine.
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Neuroleptic, or Antipsychotic Class of Drugs
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Pierre Deniker & Jean Delay
1952—Testing of Chlorpromazine
St. Anne Hospital
Paris, France
Side Effects: Tardive Dyskinesia
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Early Psychotropic Medications
• Chlorpromazine (Thorazine), 1954 McLean Hospital study—used with schizophrenics
• Reserpine, used as a tranquilizer
• Haloperidol was developed in 1958 (better known as Haldol), for psychotics, but non-sedative.
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Smith, Kline & FrenchLaboratories
c. 1956
“…helping to dispel or modify delusions, hallucinations andconfusion, while keeping the
patient calm and approachable.”
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1959
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“Patients hospitalized for many years have
returned to society”
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“helping patients gain more from psychotherapy…reduce anxiety, agitation and tension in patients…”
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MEPROBAMATE or Miltown
Anti-Anxiety Drug(1959)
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DTC (Direct to Consumer Advertising) allowed by FDA in
1997• 1996 drug companies spent 595 million on
advertising• 1997 spent 843 million on advertising• 2000 2.5 billion spent• 2007 around 25 billion, with 3 billion on
direct to consumer marketing
• From Christopher Lane, Shyness, p. 112
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Anti-Depressant TestingRoland Kuhn Nathan Kline
Tested anti-depressant,Imipramine (tri-cyclic)
at Münsterlingenasylum in Switzerland,published results 1957
Tested Iproniazid (MonoamineOxidase inhibitor MAOI)Rockland State Hospital
NY
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IMIPRAMINEtri-cyclic anti-depressant
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Neurotransmitter Theoriesof Mental Illness
• Dopamine (in excess) caused psychotic disturbances
• Acetylcholine linked to dementia
• Serotonin linked to depression
Popular from 1963-1980; recognition after this period that it was much more complex
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Newsweek (1990)
Time (1992)
Class of SSRI:selective serotonin-reuptake-inhibitor
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“Mental illnesses are biologically based brain disorders. They cannot be overcome through ‘will power’ and are not related to a person's "character" or intelligence.”
National Alliance for the Mentally Ill
founded 1979