GaryСAden
San Diego Neuropsychiatric Medical Clinic and Human Relations Center, Inc., San Diego, California 92103
In 1955, Goodman and Gilman in their textbook, The Pharmacologic Basis of Therapeutics, devoted only two chapters to psychopharmacology. The first chapter focused on barbiturates and the second on bromides, chloral hydrate, paraldehyde, and cannabis. Since then, the field of psychopharmacology has become much more sophisticated and, to be accepted, new pharmacologic treatments have had to conform to increasingly stringent scientific criteria, namely, prospective, double-blind, placebo-controlled studies. The understanding of anxiety and depression has grown considerably during this time, although it is still often difficult to separate the two in clinical practice. In addition, options for the management of these disorders have become more complex. Neuroleptics and antidepressants, including monoamine oxidase (MAO) inhibitors and tricyclics, were introduced in the late 1950s, as were the antianxiety agents, benzodiazepines. However, chlordiazepoxide was viewed with skepticism, and in 1965, diazepam was endorsed in a lukewarm fashion. As newer anxiolytic and antidepressant treatments were investigated, some (e.g., subcoma insulin, atropine coma therapy, and hypnotherapy) were never incorporated as standards because of lack of efficacy or because of failure to compare favorably with more acceptable modes of therapy. Others (e.g., electroconvulsive therapy) were used only for the treatment of the most severe complications of these disorders, such as depression unresponsive to pharmacotherapy. In some cases, treatments have withstood the test of time. These include thioridazine for the treatment of anxiety associated with allergic bronchial asthma and combined neuroleptic-antidepressant therapy for some phobic disorders associated with paranoid ideation and depression that preceded or were associated with anxiety.