Why are psychiatric drugs dysphoric, demotivating and dumbing?

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The antihistamine-derived family of psychiatric drugs all comes from roots in the dye industry (e.g. the dyes Methylene Blue and Summer Blue).

(e.g. E.F. Domino, History of modern psychopharmacology: a personal view with an emphasis on antidepressants, Psychosom Med 61 (1999), pp. 591–598.)

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The anti-histamine family include the 'anti-histamines' themselves (chlorpheniramine - Piriton, or diphenhydramine - Benylin sedating version, or promethazine - Phenergan) and more importantly the three major best selling drug classes:

1. Neuroleptics/ Antipsychotics (chlorpromazine/ Thorazine/ Largactil was the first),

2. Tricyclic antidpressants (TCAs; imipramine was the first, amitryptaline/ Elavil the best-known),

3. Selective Serotonin-Reuptake Inhibitors (SSRIs; fluoxetine/ Prozac is the best known).

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What strikes me about this anti-histamine family is that they are all broadly 'dysphoric' - that is they make a normal healthy person feel bad - or at least worse.

(Properly used they can, of course, reduce particular symptoms which are overwhelming - so that, for example, the emotion-blunting effect of SSRIs may be helpful for someone incapacitated by mood swings; nonetheless emotional blunting is intrinsically a dysphoric effect. In other words, in particular people, the dysphoric or demotivating effects may be 'a price worth paying' - but there is a price.)  

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There is also a sense that the antihistamine group are 'dumb drugs' (probably via their anti-cholinergic action), and demotivating drugs (probably via their direct (antipsychotics) or indirect (SSRIs) effect on partially blocking the dopamine reward system.

(see http://www.biopsychiatry.com)

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(Lithium and the some of the anticonvulsants are broadly of this dysphoric, dumbing and demotivating drug type too, in terms of their effects - though sometimes - especially lithium - coming from different chemical families.)

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SO - the most "popular", most widely-prescribed, most profitable family of psychiatric drugs are dysphoric, dumbing and demotivating.

(Although benzodiazepines were the most widely-prescribed and popular drugs for a while in the 1960s and early 1970s. A different era!)

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This can be compared with a broadly euphoriant (happiness-inducing), stimulating (energizing, motivating), and 'smart' (in the sense of enhancing some valued psychological functions) group of (chemically diverse) psychoative, psychiatrically-useful drugs such as opiates, psychostimulants, alcohol, minor tranquillizers and nicotine.

Opiates were used to treat melacholic depression and other forms of misery; benzodiazepines to sedate, to reduce anxiety and to calm psychosis; psychostimulants (such as amphetamines) for minor depression (dysthymia) and to relieve psychological pain and exhaustion (e.g. in terminal care).

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Alcohol (potentially benzodiazepines) is used to liberate creativity (e.g. among creative artists such as writers) and sociability. (Overall, in many societies, alcohol does vastly more harm than good - but it can do good.)

Nicotine is mostly a stimulant (working indirectly on the dopamine reward system) - like the psychostimulants-proper - providing energy, focus. Caffeine is another self-prescribed stimulant. As such, these drugs may have a significant positive function for individuals, and for society.

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The popularity of the anti-histamine family in psychiatry (and the reciprocal neglect/ horror of the euphoriant grouping) is - I strongly suspect - precisely due to their dysphoriant and dumbing quality, which means they are very seldom 'abused'.

Because patients (in general) do not like taking the anti-histamine family of drugs, for the simple reason that they make them feel worse (and they already feel bad), this enables psychiatrists to distance themselves from a 'Doctor Feelgood' image of prescribing potentially-addictive agents.

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And, of course, any euphoriant drug that makes you feel good will tend to be abused more often than drugs that make you feel worse.

But surely that is a feature not a bug?

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The fact is that the psychiatric profession (influenced by Big Pharma) prefers to make people (en masse) into miserable, dumb zombies rather than risk addiction - even though they 'know' (sometimes - at any rate it is all there in the scientific research literature, for those who take the trouble to look and learn) that the miserable, dumb zombie drugs are just as dependence-producing as the addictive ones.

The anti-histamine group produce dependence - such that the chronic patient cannot stop taking them without suffering serious withdrawal effects (very serious, in the base of anti-psychotics: acute psychotic breakdown, or permanent tardive dyskinesia)

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By contrast, top level creative work has been done on opiates, stimulants and alcohol (equivalent to minor tranquillizers, more or less) - so these would count as smart/ creative drugs, or at least potentially facilitators of smartness and creativity.

They are addictive, however, in some people; and the addiction often takes the obvious form of a craving for the euphoriant and stimulating effects.

But, used correctly, in slowly-absorbed and slowly-eliminated and less-potent forms, to treat psychological symptoms; most people do not get addicted.

And if people do become drug dependent on euphoriants, they are at least dependent on a drug which basically makes them feel better.

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Because, by contrast, there have been and currently are legions of people (including increasing numbers of children) who are chemically-dependent on prescribed (sometime compulsorily administered) psychiatric drugs which make them miserable, dumb and demotivated - especially those many millions who are dependent on the anti-psychotics/ neuroleptics.

Get that: chemically dependent on prescribed drugs that make them miserable and dysfunctional.

http://qjmed.oxfordjournals.org/content/99/6/417.full

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In a rational world, and if patients/ the public were in control of their own treatment - it would be better (I think) to use euphoriant drugs as the basis for psychiatric treatment, rather than the antihistamine group.

If forced to choose, and assuming there was also access to electroconvulsive therapy (ECT/ shock therapy; which is the most effective treatment for serious psychosis including cataonia) - I would prefer to have the euphoriant agents available and used for myself and my family; and I would be prepared to forgo the dye-anti-histamine class - especially (as now) if they were grossly over-prescribed, and indeed forced-upon people by propaganda and psychological or physical coercion. 

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What does this say about our society?

That we prescribe huge swathes of the population dysphoriant, dumb and demotivating drugs? 

Well, it says a lot about our underlying social motivation - about the kind of people that society wants us to be, is indeed increasingly forcing us to be ...

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