El papel histórico de los barbitúricos en las "curas de sueño" de los trastornos psicóticos y maníacos

Abstract

The introduction of barbiturates into clinical practice in 1904, due to the studies by von Mering and Fischer, represented the start of a new era in the pharmacological approach to various psychiatric disorders. The present article analyzes the use of these drugs in the first third of the twentieth century in patients with schizophrenia and mania within the framework of what were called "sleep cures", which were the forerunner of the major biological therapies in psychiatry. These cures consisted of inducing a state of continuous narcolepsy for more than 20 hours per day and for more than 2 consecutive weeks. Their introduction into clinical practice through the use of barbiturates is historically associated with Jakob Klaesi and the University Psychiatric Clinic in Zurich (Burghölzli, Switzerland), where they were first applied in 1920. The present article describes the methods used to apply this technique ("Dauerschlaf", "Dauernarkose") and the experience of various authors in Burghölzli (Klaesi, Cloetta, Maier, Boss, Monnier) and other centers both with Somnifen® (1920), a mixture of diethyl and dipropenyl-barbituric acid and diethylamine commercialized by the Swiss company Hoffmann-La Roche as Cloettal® (1934), a preparation that included isopropyl-allyl-barbituric acid, among other substances. In that era sleep cures were the only available treatments with a certain therapeutic effectiveness in the approach of acute psychiatric disorders. By the end of the 1930s, however, their use began to decline due to problems of safety, the considerable mortality rate, awareness of barbiturate dependence, and the gradual clinical introduction of new biological therapies for the treatment of schizophrenia.