What do we really know in psychiatry: psychotropic medications - Part 1

Abstract

Psychotropic medications are among the most prescribed drugs in the general population. They are however negatively perceived among physicians, health politicians and in society. This negative perception is due to several factors. “Pharmacological Calvinism” is an ancient phenomenon, related to the notion that patients have to use their own resources to fight their difficulties or to use “natural” means. The pharmaceutical industry is often accused of presenting biased results of clinical trials, and of profit’s obsession. Many controversies regularly arise for example about antidepressant’s efficacy and mechanism of action, about dangerousness, lethality and negative impact on brain integrity associated with long-term use of neuroleptics and of benzodiazepines’ risk of abuse and of cognitive decline. We review the history of the psychotropic drugs and of the controversies they have stimulated. Globally psychotropic drugs deserve neither excess of honor nor excess of indignity. Their efficacy could be improved but is comparable to the one observed with the usual treatments in general medicine. Progress has been made in the comprehension of their mechanism of action even if we are far from understanding them completely. This first part is dedicated to the history of biological treatments in psychiatry and focuses on neuroleptics.