Bull. Org. mond. Sante' 1959, Bull. Wid Hith Org. 21, 397-410 Psychopharmaceuticals: Effects and Side Effects NATHAN S. KLINE, M.D, F.A.C.P.1 Drugs which affect psychological behaviour are being used in vast amounts nowadays, with, in all too many cases, but scant regard for their exact uses or possible side effects. This article contains a clinical classification of these drugs, followed by an account of their principal side effects and the means ofobviating them. CLINICAL CLASSIFICATION OF PHARMACEUTICALS behaviour; whether a drug does or does not alter INFLUENCING PSYCHOLOGICAL STATES brain function is irrelevant to this purpose. A term such as " neurotropic" also prejudges the case, Even the full-time worker in the field becomes by presuming that the sole or major site of action confused at times by the plethora of names and is the brain, whereas there is certainly a real possibi- descriptive terms used for drugs influencing psycho- lity that the endocrine glands, the liver, or other logical states. The classifications of the drugs pro- organs of the body may be of equal importance. posed by various authorities during the past four There are three major categories of psycho- years are actually in quite close agreement ; difficulty pharmaceuticals: (1) drugs which restrict, limit, arises because a variety of terms are employed to restrain or depress either normal or abnormal describe a single principle of drug action, and psychological functioning, (2) drugs which increase, because at other times one and the same name is used elevate, arouse or stimulate either normal or abnormal to indicate quite different groups of pharmaceuticals. psychological functioning, and (3) compounds which I list the common alternatives, with an indication of produce abnormal psychological states of one kind those which appear to me most suitable, and the or another. reasons for such a choice. 1. The psycho-inhibitors. This term, which means The entire group of drugs that they restrict or restrain psychological activity, The most concise term designating all drugs which is selected because it describes the outstanding affect psychological function is PSYCHOPHARMA- characteristic of the entire group and is itself a CEUTICALS. " Tranquillizers " is obviously unsuitable, neutral word. The term " tranquillizers," originally since stimulants are included in this group. The used to designate a particular sub-category, is some- alternative, " psychochemicals," should be reserved times assumed to refer to all the psycho-inhibitors. for the even broader category of chemical substances, Another alternative, " depressants ", has a specific whether exogenous or endogenous, that are involved physiological meaning which implies a particular in psychological functioning. Psychopharmaceuticals mode of action. It is also too closely associated are limited to substances of exogenous origin. As with " depression ", as used in reference to the for the frequently used term " phrenotropic ", this emotional state. Professor Delay has proposed the literally means mind-influencing, and is perfectly term " psycholeptic ", which is perfectly acceptable. acceptable. The alternative " neurotropic" (influenc- It is only that the suffix "inhibitor" is a more ing the nerves), although not particularly objec- familiar one to English readers. tionable, introduces a theoretical assumption which The psycho-inhibitors may be divided into the may or may not be warranted. We should seek out following sub-categories: words that make clear the actions of pharma- (a) Hypnotics: drugs which induce sleep (what- ceuticals in terms of their effect on psychological ever other action they have). 'Director, Research Facility, Rockland State Hospital, (b) Sedatives: compounds which reduce excite- Orangeburg, N.Y., USA; Assistant Clinical Professor of Psychiatry, College of Physicians and Surgeons, Columbia ment, agitation and overactivity, whether physical University, New York, N.Y., USA or psychological. The ideal sedative would be one 828 -397- 398 N. S. KLINE which, regardless of the magnitude of the dose, they belong to or on whether new sub-categories would not produce hypnosis. must be created. (c) Muscle relaxants: pharmaceuticals which have 2. Psycho-activaztors. Professor Delay's term for as their primary action the relaxation of muscular this group of drugs is psycho-analeptics, to which tension. They apparently thereby break the feed- we would take no exception, merely preferring the back chain of anxiety tension. The effects are not suffix " activator ", which is more familiar to some dissimilar to hydrotherapy. They may be said to of us than " analeptic." constitute " a Turkish bath in a tablet ". (a) Psychomotor stimulants: compounds which (d) Ataraxics (noun: ataraxic; adjective: ata- stimulate both psychological and motor reactions. ractic): This term means freeing from turmoil and They tend to speed up mental activity, but also intro- confusion. A great deal of stress has been laid on duce distractibility and hyper-responsiveness to the capacity of these drugs to reduce, restrain and external stimuli. As a rule they will elevate the mood, restrict hypermotility and emotional excitement. If often to the point of euphoria (i.e., a feeling of more the drugs did only this there would be no reason than normal elation). Blood pressure and heart to classify them as other than super-sedatives. rate are usually increased, although appetite is The one really unique property which they possess is lessened. their capacity to remove, reverse, restrict or inhibit hallucinations (b) Psycho-stimulants: compounds which are psychopathological states, including capable of producing the same generalized psycho- and delusions-a property not possessed by the seda- logical stimulation (both mental and emotional) tives or the hypnotics. A new term was needed to that is possessed by the psychomotor stimulants. designate this action; but since the modus operandi The dosages of psychomotor stimulants are limited was unknown it seemed sensible to avoid any in large part because of the motor side effects, which implication as to whether it was biochemical, are much reduced or absent in the present sub- neurological, or something else. category. If the psychomotor stimulants could be Although the term neuroleptic, as proposed by given in sufficiently high doses the effect might be Professor Delay, has had quite widespread acceptance the same as this group of drugs. In any case, the on the Continent of Europe, it implies a more or less decreased motor effects would place them in a specified mode of action, which may be quite correct, different sub-category. but for which sufficient evidence is not yet available to be certain. Although the ataraxics are the (c) Psychic energizers: compounds which tend sub-category (of the psycho-inhibiting drugs) to to " fill the pump " rather than " speed it up ". In which the term " tranquillizer" was originally the treatment of depressed patients the mood is applied, this word has been so abused that it has raised to a normal base-line, producing a feeling of lost its original identity. To this might be added one well-being (eudaemonia), rather than elevated other legitimate objection-that the drugs do more above the base-line (euphoria). In contrast to the than merely tranquillize. stimulants, blood pressure usually tends to drop Some objection to the term has been raised since slightly, and appetite increases rather than decreases. one drug firm unfortunately patented the word Although both the stimulants and the psychic Atarax as a trade name (and for a drug which is not an energizers will reduce the need for sleep, prolonged ataraxic). This pharmaceutical house has recently usage of the stimulants tends to produce hyper- introduced the same compound under a different irritability, whereas with the psychic energizers some name, with what they consider more adequate patients can go for a year or more on three or four recommendations on dosage, so perhaps the problem hours of sleep per night. Rather than distractibility, will solve itself if the new trade name supplants the there is an increased capacity to concentrate. older one. 3. Psychotomimetics. Professor Delay's category is (e) Undetermined: pharmaceuticals with which "psycho-dysleptic ", which is also satisfactory. sufficient experience has not yet been accumulated Although the term " hallucinogenic" might be to make a clear assignment as to where they belong. applicable to a specific sub-category, it is too limited Rather than that they should be forced into a for the major grouping, since these compounds may Procrustean bed, they are tentatively placed here until produce other types of psychotic manifestations evidence is available on which of the above categories in addition to hallucinations. Although no effort PSYCHOPHARMACEUTICALS: EFFECTS AND SIDE EFFECTS 399 is made to be fully inclusive, some of the possible * meprobamate (Miltown, Equanil, Oasil) 400- sub-categories of this group would be: 1200 mg (a) Hallucinogens: producers of hallucinations * chlorpromazine (Thorazine, Megaphen, Lar- (auditory, visual, sensory, etc.). gactil) 50-100 mg * (b) Cataplexogenics: producers of rigid or un- glutethimide (Doriden) 0.5-1.0 Gm responsive conditions in which the subject does methylparafynol (Dormison) 500-1000 mg not respond to stimuli although he is fully conscious * methyprylon (Noludar) 200-500 mg and in no sense comatose. * ethinamate (Valmid) 0.5-1.0 Gm ethychlorvynol (Placidyl) 0.5-1.0 Gm (c) Euphoriants: