Ethical Implications of Psychopharmacotherapy

Abstract

The introduction of therapeutically effective psychotropic drugs in 1952 had two fundamental consequences: first, against the hitherto almost only available effective psychiatric treatments, mainly the malaria-fever therapy against general paresis and the shock therapies against psychoses, the new drug treatment seemed to be more efficacious and, above all, gentler or less aggressive, and thereby much better accepted by both patients and physicians; second, the new drugs catalysed a broad expansion of the field of brain research, providing a more rational basis for treatments. Higher standards for treatment research were a logical consequence of these developments, as well as the inclusion of ethical standards which had been hitherto largely ignored. In the beginning of this new era the antipsychotic, antidepressant, and anxiolytic effects of psychotropic drugs were experienced as beneficial and were hailed as a therapeutic break-through. However, this success became overshadowed by side-effects of drug treatment, the knowledge of which increased in the 1960s and 1970s. This proved to be important the more these negative effects on the adherence and compliance of patients and thereby on the outcome of drug treatments became recognised. Accordingly the attitude of psychiatrists changed: from the dominating (and sometimes only) aim to remove the symptoms of the disease/disorder to an attitude of taking the complaints of patients seriously, and to move the patient into a broader perspective: the focus of therapeutic aims shifted from symptom-reduction, i.e. fighting the disease, to quality of life, i.e. helping the patient to overcome his illness. This change of paradigm meant that the psychotropic medication had to be embedded in social and psychotherapeutic measures of care and rehabilitation. Simultaneously the awareness of ethical issues in therapeutic interventions in psychiatry with psychotropic drugs increased. Both the efficient application of a marketed psychotropic drug to mentally ill persons in practice and the assessment of effectiveness and safety of a potentially therapeutic drug through research imply ethical problems (Helmchen 2001). (PsycINFO Database Record (c) 2019 APA, all rights reserved)