Progress in Psychopharmacology Over the Last 40 Years

As Psychiatric Times celebrates its 40th anniversary all year long, Sara Robinson, DNP, RN, PMHNP-BC sat down to discuss 40 years of mental health care and what has changed in psychiatry.

Robinson is a psychiatric mental health nurse practitioner and a professor at the University of Maryland School of Nursing in Baltimore. She is also the director of the Psychiatric Mental Health Nurse Practitioner program at the university.

Pharmaceuticals in psychiatry have changed and developed considerably over the last 40 years, including the expanse of options a clinician has to choose from and the number of conditions these medications address. “Starting with the reintroduction of clozapine in the United States in 1990, thereafter so many atypical antipsychotics were developed and essentially joined that party,” Robinson said.

New novel mechanisms of action have also popped up, like esketamine, a fast-acting antidepressant. Recently, esketamine CIII (Spravato) nasal spray became the first monotherapy for adults with treatment-resistant depression.¹ New medications to treat tardive dyskinesia, treatments specifically approved to treat postpartum depression, and third generation antipsychotics have all developed over the last 40 years.

“There really have been so many developments in the field as we learn more, and then we get more information about the drugs that we’ve maybe been prescribing a certain way over a period of time that may require new labeling or other changes, or perhaps new indications,” Robinson said.

Dr Robinson is assistant professor and director of the Psychiatric-Mental Health Nurse Practitioner specialty at the University of Maryland School of Nursing.

References

1. Kuntz L. Esketamine CIII nasal spray: first and only monotherapy for treatment-resistant depression. January 21, 2025. https://www.psychiatrictimes.com/view/esketamine-ciii-nasal-spray-first-and-only-monotherapy-for-treatment-resistant-depression