Too Soon to Change Psychopharmacology Nomenclature?
The Neuroscience-based Nomenclature (NbN) Project recently endorsed by the APA Board of Trustees (Psychiatric News) seems, on the surface, to be a logical and straightforward approach to the issue of naming medications on a pharmacological rather than a clinical indication basis. However, I believe that the NbN will not be so simple to implement in practice.
Letters to the Editor
Readers are invited to submit letters of not more than 350 words for possible publication. Psychiatric News reserves the right to edit letters and publish them in any of its formats—print, electronic, or other media. Receipt of letters is not acknowledged. Letters should be emailed to [email protected]. Clinical opinions are not peer reviewed and thus should be independently verified.
NbN rests on two assumptions not made explicit in the article: (1) a medication has all its therapeutic effects mediated by the same biological target and (2) the biological target mediating the therapeutic effect(s) is known.
In psychiatry, we often prescribe medications that do not meet one or both of these assumptions. How would such medications be named under NbN? For example, how would we name so-called second-generation antipsychotics, such as clozapine? These medications have multiple neurotransmitter receptor targets, none of which is clearly established as mediating the therapeutic effects. How would we name doxepin, which has two distinct therapeutic effects, antidepression and sedation, mediated by distinct biological targets, biogenic amine reuptake pumps and histamine receptor, respectively?
I raised these questions at a recent APA Annual Meeting session on NbN; none of the speakers offered a convincing answer. I suggest that APA wait for these issues to be resolved before devoting resources to NbN.
DAVID A. GORELICK, M.D., Ph.D.
Baltimore, MD
Response from past APA President Maria A. Oquendo, M.D., Ph.D. She is also the chair of psychiatry at the University of Pennsylvania Perelman School of Medicine and president-elect of the American College of Neuropsychopharmacology.
The business of discovery is rarely linear, and new knowledge sometimes contradicts existing explanations for the phenomenon under study. The Neuroscience-based Nomenclature (NbN) harnesses the best science available today to promote a novel way of referring to the medications used to treat psychiatric conditions. NbN moves away from symptom or disease-based descriptions to neuropharmacological ones. Certainly, as new data reveal more precise understanding of the mechanisms by which pharmacological interventions work, NbN will require updating. Nonetheless, we do have enough data to get started. ■
