How amytal changed psychopharmacy: off-label uses of sodium amytal (1920–40)

Abstract

In the early 1930s, American neurologist and psychiatrist William Bleckwenn used sodium amytal to render catatonic patients responsive, so that he could engage in talk therapy. Bleckwenn found a new, ‘off-label’ use for this anaesthetic and anxiolytic medication in psychiatry and, in doing so, allowed for important discoveries in the diagnosis and treatment of catatonia. Pharmacological textbooks reveal a ‘label’, while the Index-Catalogue of the Library of the Surgeon-General’s Office reveals explorations ‘off label’ of barbiturates. The ‘off-label’ use of barbiturates facilitated talk therapy, heralding an important shift in psychopharmacy. Drugs previously only used as chemical restraints became a form of treatment for specific psychiatric diseases. The current strictures against off-label prescribing are overprescriptive and close off innovative new uses.

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

“…These agents are discussed in greater detail in section 'GABA-ergic pharmacotherapies'. In 1930, Bleckwenn described the use of short-acting barbiturates to 'render catatonic patients responsive' (Bleckwenn, 1932;Gershon and Shorter, 2019). Lorazepam (and to a limited extent, other benzodiazepines, such as diazepam, midazolam, clonazepam and oxazepam (Abrams et al, 1978;Benazzi, 1991;Mustafa, 2017;Schmider et al, 1999)) have now replaced the use of barbiturates (such as amobarbital and sodium thiopental) as a diagnostic challenge (sometimes called the lorazepam test or the diazepam test) for confirming the diagnosis of catatonia (Kavirajan, 1999).…”

The Duogynon controversy and ignorance production in post-thalidomide West Germany

“…Companies are sometimes accused of unethical marketing, as in the Mediator (benfluorex) scandal that rocked France in 2010 ( Lellinger, 2014 , Lellinger, 2018 ). However, in certain areas of medicine, including paediatrics, psychiatry, oncology and reproduction, ‘off-label’ prescribing is par for the course ( Balan et al, 2018 , Becker and Wilman, 2012 , Bell and Richards, 2021 , Gershon and Shorter, 2019 , Saiyed et al, 2017 ). Particular classes of drugs, including hormones, have found large markets for unapproved indications ( Hoberman, 2005 , Sanabria, 2016 ).…”

HPLC-UV Method Validation for Amobarbital and Pharmaceutical Stability Evaluation When Dispersed in a Hyaluronic Acid Hydrogel: A New Concept for Post-Traumatic Osteoarthritis Prevention

“…30,33,40,41 Amobarbital was first used in 1930 to make catatonic patients responsive, but it has also been used in research as a mitochondrial ETC member complex I inhibitor. 23,42 Coleman et al showed that by delivering amobarbital in this capacity, the treatment was efficacious at preserving the composition and structure of the articular cartilage for up to six months after an IAF. 23 Here, we have created a novel formulation for the treatment of PTOA by combining the commercially available crosslinked HA hydrogel, Gel-One Ò , with amobarbital to provide a depot style drug delivery system meant to inhibit mitochondrial ROS production.…”