Mental Illness and Neurotransmitters:

Psychopharmacology and the Prozac Era

“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

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)

Santiago Ramón y Cajal (1852-1934)

Cajal Drawingof

Purkinje Cells from

Pigeon Cerebellum

Cajal’s Anatomical Drawings

Axon-conducts impulse

Dendrite-receives

impulses from other neurons

Ramon y Cajal’s drawing of a human motor cortex pyramidal cell as tattoo!

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.

                                                               

Neuroleptic, or Antipsychotic Class of Drugs

Pierre Deniker & Jean Delay

1952—Testing of Chlorpromazine

St. Anne Hospital

Paris, France

Side Effects: Tardive Dyskinesia

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.

Smith, Kline & FrenchLaboratories

c. 1956

“…helping to dispel or modify delusions, hallucinations andconfusion, while keeping the

patient calm and approachable.”

1959

“Patients hospitalized for many years have

returned to society”

“helping patients gain more from psychotherapy…reduce anxiety, agitation and tension in patients…”

MEPROBAMATE or Miltown

Anti-Anxiety Drug(1959)

1965

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

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

IMIPRAMINEtri-cyclic anti-depressant

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

Newsweek (1990)

Time (1992)

Class of SSRI:selective serotonin-reuptake-inhibitor

“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