From Pinel’s Chains to Long-Acting Depots

“To see a person with schizophrenia today is not to witness a hopeless case—it is to witness a journey in progress.”

For centuries, schizophrenia was seen as a sentence. Families were told to expect decline, dependence, and institutionalisation. But that era is over. Advances in pharmacotherapy—particularly long-acting injectable antipsychotics—have fundamentally changed the landscape of care. And in doing so, they’ve brought us closer to a vision first imagined over two centuries ago.

🔓 From Chains to Choices: A Brief History

In 1793, Philippe Pinel, a French physician, famously removed the chains from patients at the Bicêtre asylum. He argued that people with mental illness deserved dignity, not confinement. It was the symbolic birth of moral treatment, and the beginning of a long journey toward humane, recovery-oriented psychiatric care.

Fast-forward to the 1950s: chlorpromazine became the first antipsychotic to be widely used, offering dramatic symptom relief. It was the beginning of de-institutionalisation—a shift from asylum-based care to community-based living. But the real revolution was still ahead.

💉 The Game-Changer: Long-Acting Injectables (Depots)

Today, long-acting injectable antipsychotics (LAIs) represent a breakthrough in schizophrenia management. Instead of daily pills, patients can receive medication every 2 weeks, once a month, or even once every 3 months—dramatically improving adherence, symptom control, and quality of life.

Key Benefits:

• Reduces Relapse Risk: Fewer missed doses mean fewer hospitalizations.

• Improves Insight: Patients often regain clarity and functioning, enabling engagement with therapy and work.

• Less Stigma: Monthly injections are discreet and remove the burden of daily pill-taking.

• Family Relief: Caregivers feel more secure knowing medication continuity is ensured.

🧩 Integrated, Long-Term Care: The New Standard

Pharmacotherapy alone isn’t enough—but it creates the stability needed for everything else to work. Long-acting injectables are the foundation on which we build:

• Psychoeducation for patients and families

• Cognitive rehabilitation

• Vocational support

• Relapse prevention strategies

• Assertive community outreach when needed

🏥 At Apollo Clinics – Velachery & Tambaram

We have fully integrated LAI-based schizophrenia treatment into our outpatient and home-visit services. Our focus is not just symptom reduction, but restoring the person’s role in family and society.

Whether someone is newly diagnosed or facing frequent relapses, we create a customised recovery plan—often starting with a long-acting injectable and supported by regular monitoring, family sessions, and functionality reviews.

💬 Final Thoughts

“Chains were removed 200 years ago. But it is only now—with medication that works, lasts, and supports real lives—that we have truly set people free.”

Schizophrenia is no longer the closed chapter it once was. With modern medication and compassionate care, it becomes a story of hope, purpose, and dignity.

📍 Available at:

Dr. Srinivas Rajkumar T, MBBS, MD (Psychiatry – AIIMS, New Delhi)
Consultant Psychiatrist
Apollo Clinics – Velachery & Tambaram
🔹 Areas of interest: Adult ADHD, schizophrenia, dementia care, digital psychiatry, and community mental health
🔹 Services: OP consultation, home visits, therapy guidance, medication desprescribing, and long-term care planning

📞 85951 55808
🌐 srinivasaiims.com
📍 Velachery | Tambaram | Guindy | Adyar | Nanganallur