Fifty years of psychopharmacology

Heather Ashton, Emeritus Professor of Clinical Psychopharmacology at Newcastle University, England, and long-time researcher into benzodiazepine dependency, recently gave a lecture looking back on 50 years of psychopharmacology. In the lecture Ashton takes a critical look at the pharmaceutical industry and wonders if, half a century on, we are any nearer understanding the causes of mental illness or finding a cure.

“It happens that I am old enough to have witnessed the start of the Era of Psychopharmacology - of drugs that affect the mind. Around the 1950s a whole host of such psychotropic drugs - all discovered by chance - entered the medical scene. These included the major tranquillisers such as chlorpromazine (Largactil), since developed into a range of antipsychotic drugs; it included the first antidepressants, the tricyclics and monoamine oxidase inhibitors, now joined by the SSRIs such as Prozac; and it included the so-called minor tranquillisers, the benzodiazepines Valium and Librium, now including a number of Z-drug hypnotics such as zopiclone and others.

These early discoveries were very exciting at the time, as they seemed to promise a cure for all psychiatric diseases. Schizophrenics taking antipsychotics could be, and were, let out of hospital to live in the community. Patients with depression could, allegedly, be freed from suicidal thoughts and from the perceived threat of electroconvulsive therapy (ECT). And the minor or major anxieties of life could be universally replaced with tranquillity and peaceful sleep induced by benzodiazepines. One eminent neurologist, Sir Henry Miller, even wrote that from now on all mental illness could be cured by a handful of pills and there would be no need for psychiatrists. He also memorably said that medical practice would now be so easy that it could safely be left entirely to women doctors!

At the same time it was believed, by a sort of backwards logic, that the cause of mental illness would be revealed by these drugs. Antipsychotics were found to block brain receptors for the neurotransmitter dopamine; therefore schizophrenia must be due to an excess of dopamine. Antidepressants were shown to increase the activity of the neurotransmitter serotonin; therefore depression must be due to a lack of serotonin. Benzodiazepines increased the activity of the neurotransmitter GABA, so anxiety must be due to lack of GABA.

Of course these naïve and simple hopes turned out to be in vain. 50 years later we still do not know the cause of schizophrenia or depression or even how the drugs work. The prognosis of these illnesses has changed little. And anxiety and insomnia are as common as ever. It has become clear that the drugs do not cure anything; they do, often usefully it must be said, control some symptoms but have little effect on the underlying processes. And, as everyone here knows, the drugs carry their own disadvantages. But these same drugs have made millions for drug companies.”

Read the lecture here