The Impact of Psychopharmacology on Contemporary Psychiatry

M clinical psychopharmacology can be dated from the introduction of lithium carbonate to treat mania by John Cade in Australia in 1949 or from the introduction of chlorpromazine as the first synthetic drug found to be effective in both mania and psychotic disorders in Paris in the early 1950s. Soon thereafter, the mood-elevating effects of the monoamine oxidase inhibitor, iproniazid, and the antidepressant effects of imipramine were reported. By 1960, haloperidol, the first butyrophenone antipsychotic, the first so-called atypical antipsychotic, clozapine, and the benzodiazepines also were introduced.1 That is, at least one agent from each major class of currently employed psychotropic drugs was known by the end of the 1950s. These new treatments brought about fundamental changes in the treatment of many major psychiatric disorders of unknown cause—notably, mania, depression, acute and chronic psychotic disorders, including schizophrenia, as well as severe anxiety disorders. These changes can fairly be considered revolutionary. Moreover, their impact extended far beyond improvements in treatment, and included fundamental changes in the conceptualization of most psychiatric disorders, in their diagnosis and categorization, on models for research into the nature of psychiatric illnesses, on psychiatric education, on methods and standards for experimental therapeutics, and on the organization of modern psychiatry as a clinical and academic medical specialty.