Psychopharmacologists Seek New Nomenclature for Psychiatric Drugs
Abstract
Nomenclature is not the esoteric concern of researchers and scientists, but an issue that can have a real effect on patient care, adherence to medication, and recovery.
What’s in a name?
Quite a lot, it turns out, if the name is “antidepressant,” “antipsychotic,” or “anxiolytic.”
That terminology, reflecting a decades-old tradition of referring to psychiatric medications according to the clinical indication for which they were first discovered, is now being questioned by a growing international movement of psychopharmacologists who believe the nomenclature for psychiatric medications is inconsistent with current neuroscientific understanding and potentially confusing to patients.
David Kupfer, M.D., a member of a 10-person task force of the Neuroscience-based Nomenclature, says the group is seeking a “culture change” in the way psychiatric drugs are named.
“The current nomenclature reflects a system of classification that has not received any attention for decades,” said psychiatrist David Kupfer, M.D., who was chair of the DSM-5 Task Force. “Neuroscience and the science of pharmacology have advanced enormously, but our nomenclature is a thing of the past.”
Kupfer is one of a 10-member task force of international clinicians advocating for a new nomenclature that reflects a drug’s pharmacology and mode of neurobiological action. The task force is spearheading a new joint initiative, called Neuroscience-based Nomenclature (NbN), which is the project of five international psychopharmacological research organizations: the European College of Neuropsychopharmacology, the American College of Neuropsychopharmacology, the Collegium Internationale de Neuropsychopharmacologie, the International Union of Basic and Clinical Pharmacology, and the Asian College of Neuropsychopharmacology.
In a paper published July 2014 in the journal European Neuropsychopharmacology, Kupfer and colleagues described the problems associated with traditional nomenclature: “Current psychopharmacological nomenclature remains wedded [to] an earlier period of scientific understanding, failing to reflect contemporary developments and knowledge, does not aid clinicians in selecting the best medication for a given patient, and tends to confuse patients by prescribing a drug that does not reflect their identified diagnosis.”
In an interview with Psychiatric News, Kupfer emphasized that the outdated nomenclature is not an esoteric concern of researchers or pharmacologists, but one that can have significant effects on patient care and recovery. For example, the prescribing of an “antipsychotic” to a patient with major depression or a sleep disorder can be frightening to patients and lead to nonadherence, he said.
In theEuropean Neuropsychopharmacology article, the authors proposed a new template comprising a multi-domain pharmacologically driven nomenclature. The template has five domains:
Class: primary pharmacological target and relevant mechanism
Family: reflecting the relevant neurotransmitter and mechanism
Neurobiological activities
Efficacy and major side effects
Approved indications
Kupfer said the five domains represent varying levels of complexity—depending on the needs of patients, clinicians, pharmacologic researchers, and basic scientists—but the essential feature of the template is that it would replace indication-based titles with a nomenclature based on pharmacology and neurobiological action. An example of this would be the reclassification of the drug clomipramine—casually referred to as an “antidepressant”; according to the NbN proposal, it would be reclassified as a “serotonin reuptake inhibitor.” Also under the proposal, perphenazine, referred to as an “antipsychotic,” would be called a D2 receptor antagonist.
Although regulatory bodies such as the Food and Drug Administration will be vital to the acceptance of a new nomenclature, Kupfer noted that no agency or organization is “responsible” for determining pharmacologic nomenclature. NbN hopes that by disseminating a new nomenclature to researchers, journal authors and editors, medical schools and residency programs, health care systems and insurers, clinicians, patients, and the general public, they will be able to change the way that people refer to the medications.
The movement has a vital advocate in APA President-elect Maria Oquendo, M.D., who is a member of a North American working group of the NbN. At APA’s 2016 annual meeting in Atlanta, Kupfer and Oquendo will present a presidential symposium on the subject.
“Referring to drugs based on the condition that they were first discovered to address presents several problems,” Oquendo told Psychiatric News. “Most importantly, it is at odds with what happens in a clinical encounter. Many psychiatrists have likely had conversations with patients who want to know why they are being prescribed an antidepressant for anxiety or an antiepileptic for a mood disorder. It is possible that this confusion can result in problems with adherence.”
She said that in other fields of medicine, drugs are increasingly classified according to their target receptors, enzymes, ion channels, and other biologically precise targets. Labeling medications based on an original indication divorces the treatment from the targeted biological substrates that are essential to health and recovery, she said.
“One of the best weapons we have against stigma is to reinforce the idea that psychiatric conditions are biological in nature,” Oquendo said. “A reconsideration of nomenclature would be a powerful tool in this effort.”
Kupfer agreed. “If we do not change the way we name our drugs for psychiatric conditions, we will continue the stigma and nonadherence to treatment that are too common among patients with chronic psychiatric conditions.” ■
