Note: The brand name Thorazine has been discontinued in the United States, but the active ingredient in Thorazine, chlorpromazine, is available in a variety of generic formulations. We’ll use the name Thorazine in this article, as it’s commonly used in place of chlorpromazine, and better known by patients seeking mental health treatment.
What You Need to Know About Thorazine (Chlorpromazine)
Thorazine is the brand name of a psychiatric medication called chlorpromazine. It’s considered a first-generation antipsychotic medication. It’s part of a class of medication called typical antipsychotics. Thorazine was the first antipsychotic medication approved by the Food and Drug Administration (FDA) and the first prescription psychiatric medication for psychosis used in the U.S. and around the world. Thorazine was developed in 1950 and is considered by experts as one of the most important advances in the history of mental health treatment. It’s the first medicine in the psychiatric section of the Model List of Essential Medications published by the World Health Organization (WHO).
In the rest of this article, we’ll discuss the uses of Thorazine (chlorpromazine), its effectiveness, and its side effects. We’ll also offer information on the size and scope of the need for medications like Thorazine, by sharing the latest prevalence data on the disorders for which Thorazine (chlorpromazine) is most effective.
What is Thorazine Used For?
Thorazine (chlorpromazine) is prescribed for:
- Schizophrenia
- Acute mania in patients with bipolar 1 disorder (BD-1)
- Aggressive, hyperexcitable, and explosive behavior in children under age 12
- Nausea/vomiting
- Chronic hiccups
- Tetanus
- Preoperative anxiety
Thorazine was the first medication to help patients with the symptoms above manage those symptoms successfully, leave institutions, and begin reintegration into mainstream society. The arrival of Thorazine led to what historians refer to as deinstitutionalization, a phenomenon wherein the patient population in mental institutions dropped from over 500,000 in 1955 to around 70,000 in 1994. This trend is not without controversy. To learn more about deinstitutionalization in mental health, please read these helpful articles here and here.
Now let’s answer the next logical question on this topic.
Does Thorazine Work?
Yes.
Research shows Thorazine (chlorpromazine) is an effective medication that can reduce the frequency and severity of the symptoms of schizophrenia and the manic phases of bipolar 1 disorder. Symptoms Thorazine can improve include:
Schizophrenia:
- Hallucinations: visual
- Hallucinations: auditory
- Delusions: thoughts and/or beliefs
- Thoughts: improved disorganized thinking
Bipolar 1 (BD-1):
- Mania: high energy, racing thoughts, feelings of power/importance, risky behavior
- Agitation
- Aggression
- Impulsivity
It’s worth repeating that Thorazine was the first medication that helped reduce symptoms in patients with schizophrenia. Before medications like Thorazine, the prognosis for patients diagnosed with schizophrenia was rarely positive. The advent of Thorazine ushered in a new era: patients with schizophrenia could look forward to relief. And finally, providers could tell patients, “We have a medication that can help you.”
The same is true for people experiencing the manic phases of bipolar disorder 1 (BD-1). For the first time, a medication could control the extremes of mania associated with BD-1. And like schizophrenia, the introduction of Thorazine improved the prognosis for people diagnosed with BD-1.
The medication helps, but there’s a good reason – aside from finding better, more effective medications – researchers continuously search for new, alternative medications to treat mental health disorders: the side effects.
Does Thorazine Have Serious Side Effects?
In some cases, yes.
Thorazine (chlorpromazine) is highly effective in managing the most problematic symptoms of schizophrenia. However, the side effects can be serious. Known side-effects include, but are not limited to:
- Dizziness
- Balance problems
- Blank facial expression (the mask)
- Shuffling/disrupted walking
- Restlessness
- Agitation
- Unusual/involuntary movements (tardive dyskinesia)
- Sleep problems
- High appetite/weight gain
- Menstrual/lactation issues
- Impaired sexual ability/libido
- Swelling of breasts
- Atypical lactation
- Skin problems
This list of side-effects associated with Thorazine – some of which are serious – puts patients and providers in a difficult position. The medication works, but there are risks. Ultimately, the decision to consent to treatment with Thorazine must happen only after an open and honest discussion of the risks and benefits of the medication between patient and provider.
That’s the basic information on Thorazine. We’ve shared what it is, what it’s used for, and the serious side effects it may cause. Now let’s transition, and learn about size and scope of the challenge Thorazine helps patients and treatment providers face: the prevalence of schizophrenia and bipolar disorder in the U.S.
We’ll start with schizophrenia.
Prevalence of Schizophrenia: Facts and Figures
The National Institute of Mental Health (NIMH) indicates that accurate prevalence rates for schizophrenia are difficult to obtain, for a variety of reasons. Here’s how they describe the challenges:
“Precise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses.”
However, experts collect data and verify prevalence rates to the best of their ability, which helps give treatment providers and policymakers an idea of the scope of the problem. Here’s the latest data published by the NIMH and the WHO.
Schizophrenia in the U.S. and World
- Clinical diagnosis of schizophrenia and/or related psychotic disorders:
- Between 0.25% and 0.64%
- That’s between 525,000 and 1,344,000 people
- Worldwide prevalence of schizophrenia and/or related psychotic disorders:
- Between 0.33% and 0.75%
- That’s between 19,800,000 and 45,000,000 people
Next, we’ll share the data on schizophrenia and co-occurring alcohol use disorder (AUD) and substance use disorder (SUD), as published in the peer-reviewed meta-analysis “The Link Between Schizophrenia and Substance Use Disorder: A Unifying Hypothesis.”
Here’s the data:
Schizophrenia and Substance Use Disorder
- 47% of people with schizophrenia meet criteria for SUD
- 64% of people with schizophrenia meet criteria for AUD (average prevalence from a meta-analysis)
- 50% of people with schizophrenia report chronic cannabis use disorder (average prevalence from ten studies)
- 32.5% of people with schizophrenia report cocaine use disorder (average prevalence from ten studies)
These figures illustrate the need for effective medications for schizophrenia. Among the many consequences of untreated schizophrenia, self-medication with alcohol and/or substances creates more problems than it solves. A medication that can alleviate this need improves outcomes and allows patients to engage in supportive therapy that promotes recovery.
Now let’s look at the data on bipolar disorder.
Prevalence of Bipolar Disorder: Facts and Figures
Reports published by the National Institute of Mental Health (NIMH) and the World Health Organization (WHO) shows the following prevalence rates for bipolar disorder (BD).
Bipolar Disorder in the U.S. and World: Adults 18+
- United States:
- 2.8% had BD in the past year (7.2 million)
- 4.4% had BD in their lifetime (11.3 million)
- 82.9% of those with BD had severe impairment (5.9 million)
- 17.1% of those with BD had moderate impairment (1.2 million)
- World:
- 0.5% of the adult population (40 million)
A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows the prevalence of co-occurring alcohol/substance use disorder among people with BD:
Bipolar Disorder and Substance Use Disorder
- 14% of people with BD had SUD/AUD in the past year
- 40% of people with BD had SUD/AUD in their lifetime
- Alcohol use disorder (AUD) is the most common SUD among people with BD
- AUD in people with BD decreases treatment engagement
- AUD in people with BD increases risk of suicidality
Like the facts and figures we shared for schizophrenia, and schizophrenia and co-occurring disorders, the prevalence rates of bipolar disorder and co-occurring BD-1 and SUD illustrate the need for effective medication for BD-1. Effective medication can mitigate symptom frequency and severity, which can reduce the need for self-medication. This, in turn, can decrease the risk of AUD in people with BD-1. That’s important, because the negative consequences of co-occurring BD-1 and AUD – decreased treatment engagement and increased risk of suicidality – are severe.
Thorazine: A Summary
Thorazine and its derivatives are incredibly powerful antipsychotic medications that changed mental health treatment in the 1950s. The introduction of Thorazine allowed patients to manage the more intense, severe, and disruptive psychotic symptoms associated with schizophrenia and BD-1. For the first time, patients with delusions and/or hallucinations were able to leave mental health institutions and begin reintegration into mainstream society. We encourage everyone to read the articles on deinstitutionalization we link to above. They’re informative and give full context to a major trend in mental health treatment that occurred between the late 1950s and mid-1990s in the U.S.
In 2023, Thorazine – meaning the various forms of chlorpromazine available – is an effective initial medication for psychotic symptoms in schizophrenia and bipolar disorder. However, because of the significant side effect profile, many patients consent to treatment with second-generation antipsychotics instead of first-generation like Thorazine.