CLINICAL AND THERAPY

Forty years of antidepressive drugs

Roland Kuhn

Forty years of antidepressive drugs

Summary. New antidepressants represent and extraordinary flooding of the pharmacological equipment. Depression is very frequent, determines a great suffering in the patients and may constitute a suicidal risk. The heavy burden for the public health system of new drugs cost is sometimes underlined, without the consideration of the therapeutic results and of their impact on the family and social environment.

From the experience made with the use of the new antidepressants we may obtain useful indications either for psychiatry either for general medicine. The drugs take effect not only on mental symptoms but also to somatic level. Don’t remember this may determine superfluous and expensive assessments. This refusal of the body is legate to the return of a dualistic conception about the separation between soul and body.

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2. Psychogenetic hypothesis of depressive states.



These facts allow acknowledging a biological fundament of depressive states, which – yet – has been often recognised. It is known that depressive states show a certain similarity with the mourning following the loss of a beloved relative. Also other hard events can provoke a depression. When such a cause for a depressive state is found or even only hypothesised, one speaks of a "reactive" depression and therefore considers that many depressions have a uniquely psychic origin. Consequently, distinction has been drawn between "reactive" depressions, and "endogenous" depressions, which appear without a visible cause. "Symptomatic" depressions appear as a consequence of a sure organic brain damage.

Now, reactive depressions show not only psychic but also somatic symptoms. On the contrary endogenous and symptomatic depressions show not only somatic but also psychic symptoms. Among somatic symptoms you can mention: sleep disorders, tiredness, difficulty and slowdown of mobility, of brain activity and of decision taking capability. Feelings of oppression and heaviness derive from it. Often these manifestations are more accentuated in the morning than in the evening. Psychic symptoms of depression are above all depressed tone of temper, loss of capability of feeling pleasure, of cultivating their own interests and of establishing contacts with other people, and finally delirious and suicidal ideas.

Manifestations of depressive states that occur at the level of somatic functions are called "vital", following Kurt Schneider who referenced to the philosopher Max Scheler. It is logical to think that somatic symptoms could be eliminated firstly also through an intervention on the body.



3. The discovery of medicines that act specifically against depression.



During the 2 International Psychiatric Congress, in September 1975, in Zurich, in front of a dozen of those present, I have presented a short report on a new chemical substance capable of improving and often healing depressive states. It was a summary of a more detailed account published in the special issue of Schweizerische Medizinische Wochenschrift, Swiss medical weekly (Vol. 87, pp.1135-1140, 1957), devoted to that Congress. It was the substance afterwards called imipramine (Tofranil). Chemical structure of Imipramine resembled at first sight the one of chloropromazine (Largactil). Yet, the new substance showed clearly an effect, which was different from the one of chloropromazine. It acted above all on functional disorders which – as we have just said – accompany depressions, that is on the vital symptoms.

The first paper was based on experiences collected in 40 clinical cases after an exam of a little more than one year. Once, important Belgian psychiatrist Bobon has said to me: "Your description is surprising. Particularly surprising is the fact that 95% of all that is essential for the clinical use of this substance can already be found in the first publication".





The full text has been published in Italian Psichiatria e Territorio, Vol. XIV, N, 1 (1997).

This version has been traslated by M. Garuglieri



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