Psychiatric drugs come in many kinds: there are antidepressants, antipsychotics, anti-anxiety medications, and more. But what all of these categories have in common is that they're anti- something. This is how we classify these drugs - by what they treat. Except there's a problem - very few psychiatric drugs are only used to treat one thing. Take "antipsychotics". They're used in psychosis, but they're also a key tool in the treatment of mania, a different disorder entirely. Many of these drugs are also used to help treat depression, aggression, and more. Plus, it's not even clear that they treat psychosis per se - some people argue that they work by non-specifically suppressing or masking the symptoms. So should we call them "antipsychotics" at all? If not, what are they? Well, in an
unusual paper published in European Neuropsychopharmacology
, an international group of experts say that they've devised an entirely new system of names for psychiatric medications. They called it "Neuroscience-Based Nomenclature" (NBN). The authors include some major players such as David Nutt, David Kupfer, Stephen Stahl and Guy Goodwin, and they say that the project is the culmination of a long process of high-level development
In 2008, the taskforce for psychotropic nomenclature was established. The core group was composed of representatives from 5 international organizations, with specific expertise in psychopharmacology: ECNP – European College of Neuropsychopharmacology ACNP – American College of Neuropsychopharmacology AsCNP – Asian College of Neuropsychopharmacology CINP – International College of Neuropsychopharmacology IUPHAR – International Union of Basic and Clinical Pharmacology The mission was “to examine ways of improving the current nomenclature in psychopharmacology”... Over the last 4 years, the multiaxial nomenclature was presented at major meetings held in four continents...
Here's an example of how the new terminology works in the case of the drugs formerly called "antipsychotics":
Most of these drugs are now classed as "Receptor antagonist (dopamine D2)", although some have additional classifications as e.g. serotonin 5HT2 antagonists. In other words, the new classification is based on their pharmacological action. In fact NBN might equally well be called "PBN" - pharmacology based nomenclature - but "neuroscience" was clearly considered sexier. What are the advantages of this new system? The authors say that
NbN is a pharmacological driven nomenclature of psychotropic agents that addresses the following expectations from a modern classification: (1) Embeds contemporary neuroscience advances. (2) Helps clinicians to make informed decisions about prescribing. (3) Presents a naming system that clarifies the rationale for selecting a specific psychotropic; thus, facilitating the relaying of information to patients (and enhancing adherence). (4) Enables new types of pharmacological domains and/or modes of action to fit logically into the schema. As NbN is based on scientific knowledge, and emphasizes rational psychopharmacology hence it may foster psychoeducation and reduce confusion and distrust in patients and in the general public.
There's even an app to help psychiatrists use the new system
An integral part of NbN is the NbN app; a free and convenient tool which will be updated at least on a yearly basis.
In my view, the NBN does have some advantages but there's not much new here. There's no new terminology. "NBN" is simply the idea that pharmacology should form our nomenclature. The pharmacology itself is old hat, e.g. we've known that antipsychotics are D2 antagonists for something like 30 years. We could have adopted NBN 30 years ago, in other words, but the community decided not to. Perhaps there was a reason for this? The indispensable 1boringoldman blog detects a possible ulterior motive behind NBN: he thinks it is an attempt to promote the use of antipsychotics in people who aren't psychotic. The point being that giving an "antipsychotic" to someone who is (say) depressed might seem a bit odd, while giving a "D2 and 5HT2 antagonist" would not. More broadly, perhaps the NBN is intended to promote the increased 'off label' use of psychiatric drugs, an approach that might be expected to increase drug sales. On that note, here's the Conflict of Interest section for the NBN paper...
Zohar J, Stahl S, Moller HJ, Blier P, Kupfer D, Yamawaki S, Uchida H, Spedding M, Goodwin GM, & Nutt D (2015). A review of the current nomenclature for psychotropic agents and an introduction to the Neuroscience-based Nomenclature. European Neuropsychopharmacology, 25 (12), 2318-25 PMID: 26527055
