Abstract
1) Reserpine is a remarkable and useful drug. It has a definite place in psychiatry for the alleviation of selected symptoms. It is not in any sense a psychic “specific”.
2) The physiologic effects of this drug are relatively constant. The principal ones are a fall in blood pressure, a relative bradycardia, and in adequate dosage, a slowing of the patient's spontaneous activity; feelings of weakness, tiredness and of being held down.
3) There are other effects, which are predominantly psychological and it is felt that they have nothing to do with the physiological effects per se. They are the result of the way in which the physiological action fits into the patient's way of handling and expressing his conflict (i.e. defenses). When a patient does badly it is due to the way in which the physiological effects psychologically threaten the patient. A patient does well or badly depending on this, and we have seen enhanced anxiety as well as psychoses produced by both reserpine and chlorpromazine (8).
4) Because of the above, psychotherapeutic efforts are of the greatest importance, and when used, usually overshadow the effects of the drug. We feel that no patient is treated in a vacuum. Milieu and relationship is what counts most. The other factors, though important, are adjuvants.
5) A level of 10 to 40 mg./day will control most motor over-activity. Anxiety and most panics can be handled at between 2 and 10 mg./day. The average daily dose was 7 mg./day. The average length of treatment was 26 days.
6) Side effects are frequent, but are rapidly reversible. There were no serious or irreversible toxic effects. The drug is remarkably safe.
7) Reserpine is of about the same usefulness as chlorpromazine in psychiatry. Chlorpromazine is quicker acting. Reserpine is safer. When the G.I. tract is irritated or the site of symptoms, chlorpromazine is preferable. Cardiac or cardiovascular symptomatology might indicate a preference for reserpine, especially when bradycardia is desirable. Neither is a “specific” curative agent. Both are useful for the symptomatic relief of selected symptoms. Both have their contra indications. Neither is an effective substitute for intimate human contact with the patient. Both should be used along with psychotherapy.