Anti-psychotics (also known as neuroleptics and major tranquillisers) are a broad group of drugs routinely used within psychiatric services to treat the psychotic symptoms of what psychiatrists refer to as ‘schizophrenia’. The most common psychotic symptoms are auditory hallucinations (hearing voices that others cannot hear), delusions (fixed beliefs held with total conviction in the absence of evidence to support them) and thought disorder (where a person’s thoughts seem jumbled and confused).
Standard textbooks of psychiatry typically claim that the development of anti-psychotic drugs revolutionised the treatment of mental illness and was pivotal in promoting care in the community by allowing the closures of the huge and soulless psychiatric asylums. Complementing these lofty assertions, the pharmaceutical industry spends vast amounts of money advertising their products, often claiming success rates in excess of that suggested by the scientific evidence.
If a person is unfortunate enough to experience distressing psychotic symptoms, and seeks help from psychiatric services, he will almost certainly be prescribed an anti-psychotic drug. But what is the truth about these chemicals? What follows are the facts about these medications. In providing this information it is hoped that it will help psychosis-sufferers to make an informed decision as to whether or not to voluntarily take anti-psychotic drugs.
1. Chlorpromazine: the first anti-psychotic drug
The original research effort that ultimately led to the discovery of chlorpromazine, the first anti-psychotic, was concerned with striving to develop a drug that produced more sedation and indifference in patients undergoing surgery. In 1950, a chemist named Paul Charpentier developed a number of substances for this purpose, the most effective being a compound he named RP4560 (chemical name, chlorpromazine). A surgeon, Henri Laborit, trialled it as an anaesthetic booster and found it worked well in calming patients during operations and reducing the risk of shock. Further research around the same time reported that chlorpromazine made rats indifferent to pain.
The transition to use with mentally-ill patients was conducted by two psychiatrists, Jean Delay and Pierre Deniker, who published a study in 1952 where they injected chlorpromazine into 38 psychotic patients residing in a Paris hospital. They reported marked improvements in psychotic symptoms and emotional behaviour. Other successful trials followed, and by the mid 1950s chlorpromazine was increasingly used in the USA and other western nations for the treatment of psychosis and mania. Chlorpromazine subsequently spawned the development of many other anti-psychotic medications (see next section).
2. The distinction between typical and atypical anti-psychotic drugs
Anti-psychotic drugs can be divided into two broad categories, typical and atypical. Typical anti-psychotics, of which chlorpromazine was the first, are also referred to as ‘first generation’ and were developed from the 1950s onwards. A list of the more common typical anti-psychotic medications, along with their trade names, is given in Table 1.
Typical anti-psychotics are believed to have their effects by blocking dopamine receptors in the brain. Dopamine is one of a group of chemicals called neurotransmitters that allow brain cells to communicate with each other. The specific roles of dopamine include muscle movement, motivation and the mediation of feelings of satisfaction. There is some evidence that too much dopamine activity in parts of the brain can result in hallucinations, delusions and thought disorder. By blocking the dopamine receptors, and thereby reducing dopamine activity, psychotic symptoms may be reduced.