We would also like to emphasize that it is much more difficult to establish the maintenance dose of the patient than the primary therapeutic dose. We all use maintenance dosages and for the patient who has been on the drug for a few weeks or a few months the dosage is usually reduced to a level at which we believe he will be able to function properly. To determine the maintenance dose needs a considerable amount of experimentation in some patients. It is not always easy to establish the proper amount. In some patients a definite adaptation and tolerance develops. In such cases the dosages can be raised, but we have encountered patients who even with raised dosages do not respond in the same way they did at the beginning of therapy. In these circumstances a change to another drug is definitely indicated.
There is considerable controversy in the literature as to how long the treatment of a patient should be continued when he is responding well to a drug. Should such a patient be treated for a few months and then cut off or should the patient be given the drug indefinitely? In a certain number of patients it is possible to stop the drug after a few weeks or months and then find that the patient is able to get along without it. We regret to say that in a large number of psychotic patients and also in a considerable number of neurotic patients responding to the drug, it will have to be continued for a long time — if not indefinitely. If the drug is withdrawn the clinical symptoms of the patient recur, sometimes gradually and slowly, and at other times quite suddenly. It has not yet been determined how long a patient should be maintained on a drug and more information than we have today must be obtained on this important point.
In addition to discussing uses of tranquilizing drugs in a general way, we have also been asked to discuss their abuses. It is obvious that with any new treatment approach, and especially if it develops fairly rapidly, certain abuses also develop. These abuses are even more understandable if we consider that the etiology of many of the disorders is unknown. The use of these compounds therefore cannot be applied as specifically and clearly as in disorders with a known origin. However, this does not mean that in some instances the tranquilizing drugs are not used indiscriminately.
The American Psychiatric Association recently issued a statement concerning the use of these drugs by the public for the relief of everyday tensions. It outlined the contributions made by these drugs to psychiatric practice. At the same time it pointed out that these drugs are used by the public for the relief of common anxiety, emotional upsets, nervousness, and the routine tensions of everyday living. A market research firm has stated that thirty-five million prescriptions for such drugs were filled in 1956 and that three out of ten prescriptions written by physicians in 1955 were for tranquilizers. We do not want to enlarge here on the public health aspects of this observation. You will recognize that in this situation we are not dealing with abuses alone, but we are faced with a tremendous demand to regulate nervous tension and anxiety by medication. An unsuspected large segment of the population is obviously seeking a safe tension-reducing agent. We believe that in addition to the psychiatric and medical measures which must be taken to delineate the indications for these drugs for different emotional disorders, it will be necessary to study in detail the reasons why such a great demand exists in the population for such drugs that have this tension-reducing property and why such a large segment of the population feels they are in need of such support and relief.