Tranquilizers
As their name suggests, tranquilizers are used to calm people in agitated states. Unlike barbiturates, which are minor tranquilizers used in the treatment of anxiety and neurotic disorders, a major tranquilizer, also known as an antipsychotic, is capable of alleviating symptoms of such major mental illnesses as schizophrenia, a psychotic disorder. Antipsychotics slow psychomotor activity in patients, providing them with emotional serenity and an indifference to events occurring around them.
Although the word tranquilizer suggests a tranquil, calm, or pleasant state, tranquilizers can bring on feelings of discomfort if ingested by nonpsychotic people. For this reason, these agents are seldom encountered as drugs of abuse.
The prototype of the largest class of antipsychotic drugs (the phenothiazines) was synthesized in the late 1800s, but its effects were not understood until a half-century later. The French first used tranquilizers in the early 1950s when they discovered that a derivative of phenothiazine called promethazine (Phenergan) was found to have a strong sedative effect. In 1952 the French surgeon Laborit introduced the drug as an agent to augment anesthesia induced by barbiturates. That same year researchers at a French pharmaceutical company developed another phenothiazine derivative, chlorpromazine (Thorazine), and administered it to patients the night before surgery to allay their fears and anxieties. Chlorpromazine was found to lower the amount of anesthetic drugs needed without itself inducing loss of consciousness, for it appeared to profoundly alter the patient's mental awareness. Patients who had received chlorpromazine were quiet, conscious, sedate, and appeared disinterested in the events occurring around them. These effects led doctors to try chlorpromazine in the treatment of mental illness, which resulted in discovering that the drug relieved psychotic episodes. For the first time a drug had been discovered that specifically targeted the central nervous system without profoundly affecting other behavioral or motorized functions.
American doctors determined the benefits of a naturally derived drug called Rauwolfia serpentina, which had proven effective in lowering the blood pressure of hypertensive people. Reserpine, a synthetic form of Rauwolfia , was produced by Robert Wilkins of the Massachusetts Memorial Hospital Hypertension Clinic in 1950. In an effort to further explore the benefits of tranquilizers in the field of psychiatry, Nathan S. Kline of Columbia University first tested and documented the benefits of Reserpine on his mentally ill patients. American doctors observed that their patients, like those of the French researchers, were perfectly able to participate in activities instead of becoming sleepy with increased doses. Reserpine, as well as other tranquilizers, decreases paranoia, fear, hostility, and agitation, as well as reducing the intensity of schizophrenic delusions and hallucinations. These effects are not apparent when taken by nonpsychotic people; rather, nonpsychotics experience lowered intellectual abilities when under the influence of tranquilizers.
Having become popular in France, chlorpromazine was first marketed in the United States in 1954 and soon became widely used as a treatment for institutionalized psychotic patients. The use of Reserpine for psychotic patients steadily decreased despite its initial promising results, due to its tendency to produce a number of side effects such as reduced blood pressure, diarrhea, and depression.
In the 1960s Belgium scientists developed a class of drugs called butyrophenones, which later became available in the United States as haloperidol (Halol) and droperidol (Inapsine). These drugs have provided alternatives for patients who cannot tolerate phenothiazines. Phenothiazines differ from barbiturates not only in their medical uses and behavioral effects, but also in their level of toxicity. It is virtually impossible to overdose on tranquilizers; however, an overdose of barbiturates can cause total respiratory arrest. Side effects also distinguish tranquilizers from barbiturates. These side effects invariably accompany therapeutic use of the drugs, and include increased heart rate, dry mouth, blurred vision, and constipation. Studies have also linked the use of certain tranquilizers, such as Valium, with drowsiness and an increase in traffic accidents among the elderly who use them. However, tranquilizers are not addictive and patients generally do not build up a tolerance to them, so psychotic patients can take them for years without increasing their dosage. Furthermore, cessation of tranquilizer use does not induce symptoms of withdrawal. Tranquilizers are also commonly used in animals, especially those bred for food, to reduce stress from handling and for local and general anesthesia.
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