Pills for the Mind

U.S. psychiatrists are busy digesting a mass of research reports on the revolutionary use of drugs to relieve tension and to make mental patients more accessible to treatment. How are the early "tranquilizer" drugs standing up under the test of time? And how do the new ones look? The investigators' answers fall out of date almost as soon as printed, because new drugs and fresh research reports are coming out so fast. But here are the answers to date:

Chlorpromazine (brand name: Thorazine), first of the ataraxics or tranquilizing drugs used in North America, has clinched its leadership as the one most generally effective in treating the severe mental illnesses that usually need hospitalization. The earlier used, the better. It is best in agitated cases, least effective (and occasionally harmful) in the depressed. After three years of experience with it, doctors are less jittery, though still wary, about undesirable reactions--lowering of blood pressure, damage to the liver or white blood cells.

Reserpine, synthesis of which was announced by Harvard's Professor Robert B. Woodward,*has the advantage over chlorpromazine that large doses can be given to calm acutely disturbed patients. Cincinnati's Dr. Douglas Goldman reports that it often produces turbulence after a few days, which may be mistaken by attendants for a worsening of the illness, but the turbulence is a passing phenomenon. Mississippi's Dr. Veronica Pennington finds that the most enduring tranquilization of state-hospital patients comes from reserpine; its effects persist as long as a month after the last dose has been administered. To cut down the cases of depression caused by reserpine, one manufacturer (Ciba) is combining it with a second drug, Ritalin, designed to give a lift.

Azacyclonol (brand name: Frenquel) is "an exasperating in-and-outer" because different researchers get conflicting results, says Cincinnati's Dr. Howard Fabing (TIME, Dec. 19). From 49% to 54% of state-hospital patients show good response, says Dr. John T. Ferguson of Traverse City, Mich. He finds Frenquel less potent than the two former drugs in quelling disturbed, overactive behavior, but more effective in squelching a patient's delusions.

Meprobamate (brand names: Miltown, Equanil) effects marked improvement in a somewhat smaller percentage of hospital patients than chlorpromazine or reserpine, but is most popular with the patients, as well as with millions of walkie-talkie neurotics. Noted for its sleep-inducing action and lack of side effects, it also seems to check excessive sweating (which some of the other drugs aggravate).

Besides the front runners, one or another of the research doctors has a good word for nearly all the newer drugs developed in the feverish search for still-more-effective agents:

Mepazine (Pacatal) appears twice as potent as chlorpromazine in tranquilizing effect in a veterans' hospital, reports McGill University's Dr. H. Angus Bowes. In helping to calm long-term patients into subjects for psychotherapy, it is especially effective in combination with chlorpromazine.

Promazine (Sparine), tried at two Illinois state hospitals by Dr. Lester H. Rudy and colleagues, appears to bring about some improvement in a greater proportion of patients than mepazine, but no firm conclusions can be drawn because of the small numbers treated.

Doxylamine, used since 1948 as an anti-histaminic under the name Decapryn, is proving remarkable for eliminating unpredictable outbursts of unruly behavior by normally docile patients, reports Michigan's Dr. Ferguson. Like Frenquel, it also reduces delusions and hallucinations, gives a boost to patients who have developed resistance after some improvement on other drugs.

Hydroxyzine, first made in Europe (as Atarax), and designed for the same kind of free-floating, anxious neurotics as meprobamate, has just been put on the market by Chicago's Roerig & Co. Medical reports on effectiveness will be available next week.

-Head of a series of research teams that previously synthesized strychnine, cortisone, lysergic acid and quinine.

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