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Introspections   |    
Farewell, Moban
Geoffrey Neimark, M.D.
Am J Psychiatry 2010;167:501-501. doi:10.1176/appi.ajp.2010.10010123
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Address correspondence and reprint requests to Dr. Neimark, Department of Psychiatry, University of Pennsylvania, 3535 Market St., Philadelphia, PA 19104; gneimark@hotmail.com (e-mail). Introspection accepted for publication February 2010.

Accepted February , 2010.

Copyright © American Psychiatric Association

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Farewell, Moban, though I never really got to know you as well as I would have liked.

While to some you were nothing more than a midpotency typical antipsychotic, merely an antiquated historical artifact to be memorized for certification exams, you came to occupy a valuable niche in my drug repertoire.

Unlike other antipsychotic medications that I was introduced to by well-dressed detail men or through glossy magazine advertisements, you came to me in a more natural way. It was my third year of residency and the patient I was evaluating claimed she had been on "every medication." A seasoned attending suggested you—lo and behold, a medication the patient had not been on—and the rest is history.

You quickly became my drug of choice for patients who had "been on everything." And for reasons I still do not fully understand, you were able to get the job done. No, you did not cure schizophrenia or eliminate all of my patients' symptoms, but most notably, you were tolerated and often able to produce small but perceptible changes in the lives of those who ingested you. Perhaps it was patients' unfamiliarity with you that stroked some narcissistic streak. Maybe there was something in your dihydroindolone structure that rendered you pharmacologically distinct. Or possibly you just represented one final untainted chance.

I thought you might like to know about one patient in particular, who refused to take any antipsychotic medication despite his desperately needing one. After years of slowly building rapport, I convinced him to try you, and every month he would use a considerable amount of his fixed income to faithfully purchase you.

When the letter came informing me that you would no longer be available come June, I was shocked and dismayed. As the only antipsychotic associated with weight loss, you seemed due for a renaissance, but this was not the case. There would be no glorious exit for you, simply a "Dear Doctor" letter from a pharmaceutical company and an e-mail from APA informing me of your discontinuation. Somehow I felt as though, given all of our shared experience, your departure warranted more flourish.

Despite your having never reached the celebrity status of haloperidol or chlorpromazine, you were special. I wish I had the opportunity to know more about your history, about your development, about the fanfare that accompanied your release, but alas, I never will. Future generations of American psychiatrists will likely never even know your melodious name, but for now I must content myself with the time we had and figure out what medications I am going to switch my patients to.




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