Psychology and psychiatry have a big problem - they are trapped in the past. While most areas of medicine have moved beyond symptom-based diagnosis, the mental health community is instead adding new symptom-based diagnoses, and as a result the National Institute of Mental Health has declared that the newest Diagnostic and Statistical Manual of Mental Disorders should be considered little more than a glossary of terms.
To fix that, psychiatry needs to progress from symptom-based (e.g. antidepressant, antipsychotic etc.) to pharmacologically based (e.g. focusing on pharmacological target (serotonin, dopamine etc.) and the relevant mode of action. Not only is it more scientific, it will stop patient's wondering why they are getting an antipsychotic for simple anxiety.
The new terminology is being presented to international clinicians at the European College of Neuropsychopharmacology conference in Berlin. One benefit is that new nomenclature means that it can be supported by an app, which will assist clinicians in making the correct treatment choices. This beta 1 version of this app will be also available in Berlin.
In psychiatry, drug names can cause more problems than they solve; for example, a patient may be being treated for anxiety, and yet may be prescribed an "antidepressant" or an "antipsychotic", and the stigma of being prescribed an antipsychotic can make the patient even more anxious. Often this means that patients stop taking the drug for fear of the association with the different disease.
The terminology of the drugs used by Neuropsychopharmacologists (mostly psychiatrists looking at how drugs affect the mind) is based on a classification developed in the 1960's. This often leads to confusion in both patients, and a lack of clarity in doctors.
As Professor Josef Zohar (Tel Aviv, Israel), leading the international nomenclature project put it, "As in many fields, what we know about drugs has evolved enormously since the 1960s, but the names we use to describe these drugs have not evolved in 50 years. As an analogy, I mostly use my smartphone to type SMS text messages, yet I would not call it a "typewriter", as I would have in the 1960's; the names need to reflect our contemporary knowledge. If this is true of electronics, it is certainly true of medicines".
Most drugs have more than one effect, and this can lead to great confusion in patients. For example, some 'antipsychotics' are used to treat depression (somewhat like Aspirin is taken for headaches, but also to help prevent heart disease). So the Joint Taskforce on Nomenclature has agreed that the nomenclature of drugs used in mental health need to reflect how the drugs work, rather than any one single use (This is what already happens in some fields such as hypertension).
Zohar continued. "This is more than just a name change. This will change the way we talk about medications, the way we use medications and the way we explain to our patients why we are selecting the specific medications for them. We can also use the new naming system to help a clinician make informed decisions. We are proposing that the naming system will have 4 components or 4 axes".
Axis 1 describes pharmacological target and mode of action
Axis 2 describes approved indications – what the drug is used for
Axis 3 describes efficacy and major side effects
Axis 4 gives the neurobiological description.
As an example the drug fluoxetine (also known as Prozac, etc.) is currently classified as an antidepressant, but is also used for bulimia and other indications. Obviously, suffering from bulimia and being given an antidepressant is potentially confusing. Under the new classification fluoxetine would be described as follows:
- Class/ mechanism: Serotonin, reuptake inhibitor
- Indications: Major depressive disorder, obsessive compulsive disorder, bulimia nervosa, panic disorder (and others)
- Efficacy: Improves symptoms of depression and anxiety and reduces compulsive behaviour and obsessional thoughts.
- Side effects; GI symptoms, anxiety, changes in sleep early in treatment, sexual dysfunction
- Neurobiological description: Neurotransmitter actions / Physiological / Brain Circuits are all listed in the new classification.
Note: the above points 1-4 are not the complete listing for Fluoxetine, please see the Nomenclature book for more details.
American College of Neuropsychopharmacology representative to the expert group, Professor David Kupfer (University of Pittsburgh), said:
"This change in terminology represents a major shift in the way which clinicians, and their patients, will think about the drugs they use. This new system is being launched at the ECNP in Berlin, so there is a long period of negotiation and discussion to come before we get complete agreement. Nevertheless, this will mean a real change in the way we talk about the drugs used in psychiatry and neuroscience".