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Chlorpromazine is authorised in the world under the following brand names: Chlorpromanyl (discontinued), Intensol, Largactil Liquid, Largactil Oral Drops, Novo-Chlorpromazine, Thorazine Spansule.

Most of the reliable information on the action of these compounds relates to psychotic patients. A considerable literature also exists on then-use in neurotic patients. However, the interpretation of data with these patients is far less reliable than with psychotic patients. The oral use of chlorpromazine and reserpine in neurotic patients shows that both are effective. We do not know in what type of patient which drug would be preferable and therefore the choice of drug prescribed is dependent upon what drug the individual psychiatrist or physician thinks is the most suitable and effective. Sometimes in prescribing for these patients the physician is motivated not only by the known efficacy of the drug, but also by the fear of complications. For instance, the physician may be influenced by the knowledge that chlorpromazine, regardless of dosage, may produce an obstructive jaundice in a certain percentage of patients and that some patients may develop agranulocytosis, the most serious complication with chlorpromazine. Reserpine does not produce too many physical complications. On the other hand, a fairly large number of patients have been reported to have developed a depression while on a Rauwolfia preparation, and when present, a mild depression was aggravated by the administration of the drug. We may add that a depression may also be precipitated by chlorpromazine but with much less frequency than when Rauwolfia preparations are used. Where there is a history of gallbladder disorder or of skin allergy in neurotic patients, it is preferable to use reserpine. In patients with a history of depressive attacks or where depression is a part of the clinical symptomatology — and many neurotic patients have mild depressive features — preparations other than the Rauwolfia compounds are preferred. However, there are so many exceptions to this rule that these contraindications will have to be examined carefully when we have more knowledge. We have seen patients with clinically depressive features in whom reserpine did not precipitate a depressive attack. We have also seen patients with a history of jaundice where chlorpromazine was tolerated very well.

The indications for using the tranquilizing drugs are still more or less in a chaotic state. If you examine the literature, published both here and abroad, you invariably arrive at the conclusion that these drugs should be used for every psychiatric condition, regardless of origin, and if you use these drugs long enough in adequate dosages all patients will be cured. Some of the publications available are frankly contradictory and a clear-cut table indicating when to use the tranquilizing drugs has not emerged. Today we are still in the state where practically every patient receives one or the other of the drugs for a time and if he does not respond then some other treatment is tried. However, some observations now available suggest that the tranquilizing drugs have specific indications. We believe that in a year or two these indications will be much more sharply drawn and more clearly understood than is the case today.

All investigations agree that the drugs are most effective in psychotic patients who show a so-called over-reaction, who are excited, tense, and anxious, and in patients who have delusions and hallucinations. Apathetic, driveless, emotionally burned-out patients do not respond too well to the tranquilizing drugs. We are aware of the difficulties, at times clinically confusing, that occasionally arise in a patient who appears to be apathetic and driveless and underneath has a great deal of tension. To separate the true apathetic from the pseudo-apathetic, the true driveless from the pseudo-driveless, will be a future psychiatric task.

Without going into great detail we should like to outline some of the observations made on the tranquilizing drugs in different psychiatric conditions. As in any other psychiatric treatment, it is permissible to discuss the reaction of a particular group of patients to the drugs and especially from the point of view as to what extent certain psychiatric symptoms or syndromes respond. This, however, should not obscure the fact that treatment with drugs alone or in combination with other treatments should be an individual undertaking and should take into consideration all the special physical and emotional factors which appear in the patients’ symptomatology.