The pharmaceutical industry and the new drugs

By | July 7, 2012

The pharmaceutical industry played a significant part in establishing the role of the new psychiatric drugs in the 1950s and 1960s. For doing so it is sometimes credited with helping transform psychiatry into a modern ‘medical specialism’. The large-scale marketing campaigns that helped to establish the use of the early neuroleptic and antidepressant drugs are documented in subsequent posts, as well as the industry’s role in propagating the modern view of depression as a common condition treatable with drugs.

The industry also helped to disseminate and reinforce the view that the new drugs were disease-specific treatments. Advertisements for antidepressants in the British Medical Journal and the American Journal of Psychiatry stress their specificity. Niamid (nialamide, a monoamine oxidase inhibitor (MAOI)-type antidepressant), marketed by a branch of Pfizer, was described as a ‘specific treatment’ for ‘depressive illness’ (Niamid advertisement 1962). Laroxyl (amitriptyline) was heralded as a ‘potent antidepressant’ by one of its makers, Roche (Laroxyl advertisement 1962) and was described as being a ‘specific treatment for depression and anxiety’ by another manufacturer (Saroten advertisement 1962). Nardil (phenelzine) was claimed to be a ‘true antidepressant which acts selectively on the brain’ (Nardil advertisement 1961) in a British advert and a ‘corrective’ that ‘helps remove the depression rather than masking the symptoms’ (Nardil advertisement 1960) in an American advert. Adverts for the early neu-roleptic Stelazine used the term ‘antipsychotic’ from 1960 in the American Journal of Psychiatry to stress the specificity of action. ‘Stelazine’, it is claimed ‘exerts little or no sedative effect; rather Stelazine calms hyperactive patients chiefly because of its rapid effect against the psychotic process’ (Stelazine advertisement 1960). The advert also notes that ‘a striking response to Stelazine is the rapid reduction or elimination of delusions and hallucinations’. An advertisement for Largactil (chlorpromazine) in the British Medical Journal in 1961 was accompanied by a reproduction of a picture by Picasso of distorted machinery and a small caption picture of a brain. The implication is that the brain of someone with schizophrenia is like malfunctioning machinery that needs to be repaired with drugs.

However the industry’s attitude to treatment specificity in this period was ambivalent. On the one hand the idea that drugs act directly on the biological basis of a disorder lends credibility and respectability to drug treatment, but on the other hand, it may limit its application. The idea that psychotropic drugs can induce effects that may be useful in a variety of situations is likely to create a larger market than the idea that they cure a specific psychiatric disease.

Therefore some advertisements emphasised the sedative action of tri-cyclic antidepressants. Amitriptyline, for example, was frequently recommended for its sedative action. It was described in one advert as having ‘intrinsic tranquillising properties’ and ‘additional sedative action which relieves insomnia, agitation and anxiety'(Tryptizol advertisement 1964). Drinamyl, the combination of amphetamine and a barbiturate marketed by Smith Kline & French, was described in one advertisement as ‘the standard treatment for mental and emotional distress in everyday life’ (Drinamyl advertisement 1962), although the same compound was promoted as having a ‘proved antidepressant effect’ in an American advertisement (Drinamyl advertisement 1960). Roche described the ‘typical indications’ for Parstellin, a combination of a neuroleptic and a monoamine oxidase inhibitor antidepressant, as ’emotional fatigue, menopausal symptoms, and many psychosomatic disorders’ (Parstellin advertisement 1962). Many drugs were still advertised for their sedative or stimulating properties. In the 1960s several neuroleptics were marketed as everyday tranquillisers including Stelazine (trifluoperazine), Trilafon (per-phenazine), Permitil (fluphenazine) and Melleril (thioridazine), which was described as ‘a tranquilliser pure and simple’ (Melleril advertisement 1962) and there were numerous adverts for benzodiazepines such as Librium. In 1964 an advertisement recommended Largactil for the ‘querulousness of old age’ (Largactil advertisement 1964). Ritalin was promoted as an ‘antilethargic’ for the period ‘after childbirth, in convalescence, mild depression, oversedation, the menopause and in many old patients’ (Ritalin advertisement 1964). However stimulants were also referred to as ‘antidepressants’ in adverts in the 1960s (Dexedrine advertisement 1960). The action of neuroleptics on psychosis was also described explicitly in drug-centred terms in some advertisements as late as the 1960s. Trilafon, or perphenazine, a drug still used in the United States was advertised as producing ‘symptomatic control of overactivity in psy-chopathological states’ and inducing ‘rapid response and early alteration of undesirable behaviour’, minimising ‘the problem of sedation and lethargy’ (Trilafon advertisement 1960). Prolixen (fluphenazine) was described as an ‘exceptionally effective behaviour modifier’ (Prolixen advertisement 1960). The way in which this emphasis on drug-induced effects facilitated a wider market is clear as many adverts emphasised the numerous indications for their neuroleptic tranquillisers. An advert for Thorazine (chlorpromazine) claimed it controlled ‘agitation – a symptom that cuts across diagnostic categories’ (Thorazine advertisement 1960).