Depression Symptoms Treatment

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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.

The drugs, of course, are used not only in psychotic patients but in many neurotic patients. The tranquilizing drugs are prescribed in large quantities outside of mental hospitals and practically every physician today prescribes these drugs to patients when he assumes that some emotional symptomatology is present. Observations made in this country do not confirm some of the statements made in the European literature that many severely neurotic patients recover after receiving the drug for a few weeks. In some anxious patients the drugs are of great value. In others with similar symptomatology they are not effective. There are neurotic patients who, under the influence of the drugs, and more particularly the Rauwolfia preparations, develop symptoms of depersonalization, depression, and other unwarranted manifestations, which aggravate their condition and interfere with their treatment. The value of these drugs in neurotic patients is far from being adequately assessed. It is undeniable that some neurotic patients function better under the influence of the drugs. In other neurotic patients no improvement is noted. We feel that the drugs are more effective in the gross mental disorders than in the neuroses, but much more investigation will be necessary to arrive at a definite conclusion.

The drugs are quite effective in psychosomatic cases and especially in those cases where a great deal of vegetative nervous system discharge is present. In these patients the drugs contribute a great deal to the better management of the patient.

There is considerable discussion in the current literature about dosages of the tranquilizing drugs. The dosage is a highly individual affair and actually no standards can be quoted. For instance, some patients respond to 50 mg. of chlorpromazine and others need 1500 mg. Some patients respond to 1 mg. of reserpine and others need 18 mg. One of the common errors in the treatment of these patients is the fact that these great dosage ranges are not recognized and the proper dosage has not been worked out and adapted to the patient’s condition. Some have raised the question as to how far we should go in dosage to achieve clinical results. Some use very high dosages. We feel that we should increase the dosage considerably if the patient does not respond. For instance, with chlorpromazine we use dosages up to 1200 mg. but I know of some physicians who use up to 4000 mg. daily. It is not yet definite how far we should go and there is a point of no return in clinical improvement. With reserpine some use up to 18 to 20 mg. daily. Again we do not know how far we should raise the dosage to improve the patient’s condition. We believe that with chlorpromazine the patient should be given up to 1200 mg. and with reserpine up to 18 mg. for a period of time before deciding that the patient will not respond to the drug.

Considerable difficulty arises in determining the dosages in ambulatory treatment. Some do not wish to give the higher doses because they feel this would create complications. Accordingly, the patient is often kept on a comparatively low dosage and, if he does not respond, the treatment is given up or a trial of other drugs begins, even though the patient would have been well controlled by receiving a higher amount of the first drug. In ambulatory patients it is important to decide how far the dosage of the drug can be raised without interfering with the ambulatory status. If the patient does not respond, temporary hospitalization is advisable in order to use higher doses rather than to discontinue treatment and assume that the patient does not respond to the medication. The second issue, which is also controversial, is how long the use of the drugs should be continued. Some advocate that the drug be discontinued if the patient does not respond within two months. We feel that this is probably too short a time to judge and would prefer to set the termination date after four months. This implies that the patient should have received the drug in adequate amounts. If a patient does not respond to one of the tranquilizing drugs the question arises, should he be switched to another? This can be done and there are patients who respond better to one compound than to another. Observations show, however, that a considerable number of patients who do not respond to one also do not respond to another of the drugs. We believe that a considerable amount of research will have to be done on this aspect of drug therapy and if possible try to learn the physical and psychic indications that determine which drug should be used.