Saturday, 22.02.2020

Thomas A. Ban
Neuropsychopharmacology in Historical Perspective
Education in the Field in the Post-Neuropsychopharmacology Era
Prologue
Educational Series 2. Bulletin 2

 

 

     Introduction of drugs with demonstrable therapeutic efficacy in mental illness in the 1950s ushered in a “psychopharmacological era” in psychiatry. By the end of the 1980s pharmacotherapy has become the primary form of treatment in psychiatry; the site of psychiatric practice shifted from psychiatric hospitals to the community and the scope of psychiatry was extended to include dimensional anomalies of abnormal behavior (Ban 2006).

     By the time the first set of therapeutically effective psychotropic drugs was completed, in the late 1950s, “psychometric” research, dormant in psychiatry from the early years of the 20th century, re-emerged and in the years that followed it received wings in the evaluation of a rapidly growing number of psychotropic drugs. By the end of the 1960s, “psychometrics” dominated clinical drug development for mental disorders (Bech 2012). 

     As time passed, employment of consensus-based diagnoses and psychiatric rating scales in clinical investigations generated the necessary information for an evidence-based practice of psychiatry, and the use of scales in which the measurement of change embraced quality of life and adaptation to society has rendered “measurement-based care” in psychiatry, a distinct possibility by the end of the 1990s (Bech 2016).

     Parallel with this development rapid advances in medical technology lead to the extension of pharmacology from behavioral pharmacology to neuropharmacology, the discipline dedicated to the study of the mode of action of psychotropic drugs in the brain. It also lead to the birth of “neuropsychopharmacology,” the combined discipline of psychopharmacology and neuropharmacology. By linking the effects of a “psychotropic drug” on mental pathology with their effect on the structures involved in their mode of action, research in neuropsychopharmacology raised expectations for developing rational pharmacological treatments in psychiatry (Ban 2004)

     During its first 50 years neuropharmacology was a rapidly advancing field and by the 1960s it replaced behavioral pharmacology in the screening and preclinical evaluation of psychotropic drugs. In the 1970s, research in neuropharmacology was extended from cerebral monoamines to neurotransmitter modulators, peptides and prostaglandin. During the same period, there was also a shift of interest from pre-synaptic to post-synaptic mechanisms and from studies of neurotransmitter biochemistry to studies of receptor affinities (Sulser 2011). By the end of the 20th century biochemical and electrophysiological studies in neuropharmacology were complemented with studies of brain metabolism with the employment of brain imaging techniques (Sokolov 2014).

     Sequencing of the human genome began in 1989 and by the time it was completed in 2004 the “psychopharmacological era” in psychiatry and the “neurotransmitter era,” in neuropharmacology, were replaced by a “molecular genetic era,” in both.  Adoption of the new molecular genetic methodology has opened up a new perspective for studying the molecular substrate of mental illness with its genetic underpinning and the mode of action of psychotropic drugs (Ban and Ucha Udabe 2006).

     Today, the “neuropsychopharmacological era” (the “psychopharmacological era” in psychiatry and the “neurotransmitter era” in neuropharmacology) is history with a flood of information left behind in numerous publications (in journals and books) from the period. There are also two series of source books available with authentic information from some of the major players (researchers) of the period about their contributions. One of these series, “The History of Psychopharmacology as Told in Autobiography” (four volumes), sponsored by the Collegium Internationale Neuro-Psychopharmacologicum, was edited by Thomas A. Ban, David Healy and Edward Shorter (1998, 2000, 2002, 2004). The other, “An Oral History of Neuropsychopharmacology The First Fifty Years Peer Interviews” (10 volumes), sponsored by the American College of Neuropsychopharmacology, was edited by Thomas A. Ban (2011) in collaboration with Barry Blackwell (2011 a,b), Max Fink (2011), Samuel Gershon (2011), Martin Katz (2011), Herbert Kleber (2011), Carl Salzman (2011) and Edward Shorter (2011), each responsible for the editing of different volumes. These two series, but especially “An Oral History” that was structured in a manner that each volume dealt with a different area of research, brought to light the major contributions and progress made during the neuropsychopharmacological era in all the different areas of research contributing to neuropsychopharmacology. At the same time, they also focused attention on the fact that in spite of all major advances in the neurosciences, virtually no progress has been made in our understanding during the second half of the 20th century about the pathophysiology and the underpinning biology of mental illness. They also brought to attention that in spite of all the advances in the clinical methodology used in the clinical development and evaluation of psychotropic drugs, we have no single clinically more effective or selective psychotropic drug available for clinical use at the dawn of the 21st century than we had available by the end of the 1950s.

     The objective of “Neuropsychopharmacology in Historical Perspective” is to provide an education that might allow the identification and removal of the obstacles that blocked development in the field during the first epoch in its history.

 

References:

 

Ban TA. Neuropsychopharmacology and the history of pharmacotherapy in psychiatry. A review

of developments in the 20th century. In:  Ban TA, Healy D, Shorter E, editors. Reflections on

Twentieth Century Psychopharmacology (The History of Psychopharmacology and the CINP. As

Told in Autobiography. Volume 4). Budapest: Animula; 2004, pp.697-720.

 

Ban TA. Academic psychiatry and the pharmaceutical industry. Progress in Neuro-

Psychopharmacology & Biological Psychiatry 2006; 30: 429-41.

 

Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Brentwood: American College of Neuropsychopharmacology; 2011. 

 

Ban TA, Healy D, Shorter E, editors. The Rise of Psychopharmacology and the Story of CINP. (The History of Psychopharmacology and the CINP. As Told in Autobiography. Volume 1).  Budapest: Animula; 1998.

 

Ban TA, Healy D, Shorter E, editors. The Triumph of Psychopharmacology and the Story of

CINP. (The History of Psychopharmacology and the CINP. As Told in Autobiography. Volume

2). Budapest: Animula; 2000.

 

Ban TA, Healy D, Shorter E, editors. From Psychopharmacology to Neuropsychopharmacology

and the Story of CINP As Told in Autobiography. (The History of Psychopharmacology and the

CINP. As Told in Autobiography. Volume 3). Budapest: Animula; 2002.

 

Ban TA, Healy D, Shorter E, editors. Reflections on Twentieth Century Psychopharmacology

(The History of Psychopharmacology and the CINP. As Told in Autobiography. Volume 4).

Budapest: Animula; 2004.

 

Ban TA, Ucha Udabe R. Concluding remarks. In: Ban TA, Ucha Udabe R, editors. The Neurotransmitter Era in Neuropsychopharmacology Buenos Aires: Polemos; 2006, pp. 266-74.

 

Bech P. Clinical Psychometrics. Oxford: Wiley Blackwell; 2012.

 

Bech P. Measurement-Based Care in Mental Disorders. Cham: Springer; 2016

 

Blackwell B, editor. Special Areas. In: Thomas A. Ban editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 7. Brentwood: American College of Neuropsychopharmacology; 2011.

 

Blackwell B, editor. Update. In: Thomas A. Ban editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 9. Brentwood: American College of Neuropsychopharmacology; 2011.

 

Fink M, editor. Neurophysiology. In: Thomas A. Ban, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 2.  Brentwood: American College of Neuropsychopharmacology; 2011. 

 

Gershon S, editor. Neuropsychopharmacology. In: Thomas A. Ban editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 5. Brentwood: American College of Neuropsychopharmacology; 2011.

                          

Katz MM, editor. History of the ACNP. In: Thomas A. Ban editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 7. Brentwood: American College of Neuropsychopharmacology; 2011.

 

Levine J, editor. Psychopharmacology. In: Thomas A. Ban editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 4. Brentwood: American College of Neuropsychopharmacology; 2011.

                          

Salzman C, editor. Diverse Topics. In: Thomas A. Ban editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 8. Brentwood: American College of Neuropsychopharmacology; 2011.

 

Shorter E, editor. Starting Up. In: Thomas A. Ban editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 1. Brentwood: American College of Neuropsychopharmacology; 2011. 

 

Sokoloff L. Per aspera ad astra. The road to metabolic mapping and imaging of local functional activity of the nervous system. In: Ban TA, Healy D, Shorter E, editors. Reflections on Twentieth Century Psychopharmacology. (The History of Psychopharmacology and the CINP. As Told in Autobiography. Volume 4). Budapest: Animula; 2004, pp.277-89.

 

Sulser F, editor. Neuropharmacology. In: Thomas A. Ban editor. An Oral History of Neuropsychopharmacology. The First Fifty Years, Peer Interviews. Volume 3. Brentwood: American College of Neuropsychopharmacology; 2011. 

 

January 25, 2018