For quite some time the credit for ushering the modern era of psychopharmacology was given to two Frenchmen, Delay and Deniker, who showed that chlorpromazine, a compound that was synthesized by Germans late in the last century, was not just a nonspecific calming agent but an antipsychotic (1952). Recently the credit has shifted to John F. Cade, the Australian, who, while using lithium in an attempt to isolate from urine the toxin responsible for mania, stumbled upon its antimanic properties (1949). This view of history is so ingrained in the collective consciousness of psychiatrists that I was not surprised that even the director of the National Institute of Mental Health, Dr. Steven Hyman, reiterated it in his article in the March 3 issue.

While it certainly does not sound fair if one insists that the fathers of modern psychopharmacology are two obscure physicians of a third-world country and the studies took place in Calcutta and not in Paris or Down Under, nevertheless, for the record, the honor for beginning the modern era of psychopharmacology (and for that matter, cardiopharmacology) goes to Sen and Bose (Sen G, Bose KC. Rouwolfia serpentina: a new Indian drug for insanity and high blood pressure. Indian Med. World 2:194-201, 1931; reference obtained from Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 8th ed. New York, NY: Pergamon Press, 1990), for introducing reserpine to the Western science.

While officially my national pride would allow no other but Sen and Bose to have the distinction, in my heart I consider Sigmund Freud as the modern psychopharmacologist. His studies on cocaine were the first systematic attempt to find a psychopharmacological agent. While cocaine’s drawbacks make it clinically impractical, nevertheless it does remain the first monoaminergic neurotransmission-enhancing drug used medically for treating psychological symptoms, and if we are willing to consider psychostimulants as psychotropics, we have no choice but to give the same status to cocaine.

And I cannot take leave without mentioning that cocaine’s pharmacological properties were not discovered by serendipity but such finely executed minute observations that it puts all our modern rating scale–driven psychopharmacological studies to shame.

Surendra Kelwala, M.D.

Livonia, Mich.