Lessons from the history of antipsychotic discovery: part 1 - initial insights

The recent introduction of the first non-dopaminergic antipsychotic marks a pivotal moment in psychopharmacology. This article revisits the development of chlorpromazine, the world's first licensed antipsychotic, and considers what its history reveals about innovation in psychiatric drug discovery. Chlorpromazine emerged in the early 1950s as a treatment for surgical shock. Its subsequent recognition as an antipsychotic transformed psychiatric care, ushering in the modern era of psychopharmacology. This article argues that chlorpromazine's success was not serendipitous: it depended on specific enabling conditions, including rigorous behavioural neuroscience, astute clinical observation across disciplines, close collaboration between clinicians and industry, and relatively agile regulatory frameworks. Understanding these factors is essential as psychiatry enters a new phase of drug development for the treatment of psychosis.