This chapter focuses on drug development for psychiatric as opposed to other central nervous system (CNS) indications such as neurological conditions, pain, and sleep. It provides an overview of how CNS drug development has evolved over its relatively short history of perhaps 50-100 years as well as to provide some sense of how it might evolve in the not-too-distant future. Chlorpromazine and other phenothiazine molecules were synthesized around the turn of the last century and some were initially used to treat pinworm infestation. However, chlorpromazine over the last 50 years has come to play a pivotal role in the modern era of clinical psychopharmacology. CNS drug development principally focused on serotonin selective reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors SNRIs, atypical antipsychotics, and cholinesterase inhibitors. The current development of drugs for Alzheimer's and other neurodegenerative diseases could be a model for how future CNS drug development might proceed.

Pharmacological treatment during pregnancy and breastfeeding requires serious consideration of safety concerns. This chapter provides the evidence for the safety of agents used in the treatment of mood and anxiety disorders during pregnancy and lactation. Benzodiazepine treatment of anxiety during pregnancy should be secondary to other therapies such as serotonin selective reuptake inhibitors (SSRIs) and psychological approaches. Buspirone is used for its modest anxiolytic effect and low potential for dependence. Hypnotics may be required for short-term use in during pregnancy, or postnatally. Many antidepressants have well-documented records of safety and have a history of use during pregnancy and breastfeeding. SSRIs are often the first choice of antidepressant agent administered to patients presenting with a major depressive episode. The most commonly used mood stabilising agents for the treatment of bipolar disorder are associated with significant risks of foetal malformations and toxicity.