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Better Than Prozac: Creating the Next Generation of Psychiatric Drugs: Samuel H. Barondes

Introduction:

In the early 196os, when I began my training in psychiatry, the field was in a state of great excitement In the previous decade several drugs that had been developed for other purposes were unexpectedly found to be useful for the treatment of mental disorders For the first time a daily dose of pills could eliminate the bizarre ideas of people unth schizophrenia and relieve the agonizing self-hatred of people unth severe depression

Adding to the excitement was a flurry of findings about the effects of these drugs on neurotransmltters, the brain chemicals that transmit signals between nerve cells Once this became clear, a search was undertaken for still more chemicals that influence the actions of neurotransmitters This led to the development of many new medications, some after long nenods of experimentation The most famous, fiuoxetlne (Prozac), was identified in the early 197os* as a chemical that augments neurotransmlsslon by serotonln, and marketed as an antldepressant in 1987 Related drugs soon followed, joining many others as tools for changing neurotransmlsslon in the brain

These new drugs, which have a better balance of properties than those dtscovered in the 1950's, transformed the practice of psychiatry. Before they came on the scene, most psychiatrists were mainly interested in psychotherapy and rarely prescribed pills. They believed that drug treatment should be restricted to the small fraction of their patients with severe mental disorders and frowned upon the use of drugs for milder forms of mental distress Now most people who consult psychlamsts leave the office with a prescription for at least one medication More than a hundred million people around the world are presently talung psychiatric drugs Many more are wondenng whether they or their loved ones might also benefit from these medications

The aim of this book is to describe the origins and properties of these psychiatric drugs and to explain how new ones are being created Part I is about the evolution of those that are widely prescribed today. The main point I will make is that the latest ones are generally improved versions of those that were accidentally discovered decades ago, and that it will be difficult to make further improvements until we have a better understanding of the origins of mental disorders The emphasis of Part II is on genetic and neurobiologcal studies of these disorders and of the effects of psychiatric drugs on the brain These lines of research are rem,.qgoratmg this field and unll guide the design of more effective medications With regard to my biases, let me confess at the outset that I have been an enthusiastic fan of psychiatric drugs for more than forty years I have prescribed them for patients with a wide range of ailments and have seen many excellent results I have worked with them in the laboratory, taught about them to medical students and young psychiatrists, gven advice about them to public agencies and private foundations, and participated in the creation of new ones by serving on the scientific advisory boards of pharmaceutical and biotechnology companies

But I have also seen these drugs sometimes fail miserably because of their many flaws Even the best of them are blunt instruments that have a large number of effects on the brain, only some of which can be considered therapeutic. As you grow familiar wth these fascinating chemicals in the course of this book, you wall come to understand the reasons for their limitations and what must be learned before we can expect substantially better ones.

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