A proposal for an updated neuropsychopharmacological nomenclature

Abstract

Current psychopharmacological nomenclature remains wedded in 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 (e.g. prescribe "antipsychotics" to depression). Four major colleges of Neuropsychopharmacology (ECNP, ACNP, Asian CNP, and CINP) proposed a new template comprising a multi-axial pharmacologically-driven nomenclature tested by four surveys. The template has five axes: 1-class (primary pharmacological target and relevant mechanism); 2-family (reflecting the relevant neurotransmitter and mechanism); 3-neurobiological activities; 4-efficacy and major side effects; and 5-approved indications. The results of the surveys suggest that the clinicians found the available indication-based nomenclature system dissatisfactory, non-intuitive, confusing, and doubt-inducing for them and the patients. The proposed five-axis template seeks to upend current usage by placing pharmacology rather than indication as the primary axes, with the proposed nomenclature relating primarily to Axis 1-the class, and usage of the other axes would largely depend upon the extent to which the clinician seeks to deepen the scientific and clinical base of his involvement. A significant proportion of the participants in the four surveys were in favour of the proposed system, a similar number wanted to consider the idea further, and only a small proportion (8.6%) were against it. The proposed five-axis pharmacology based nomenclature template is a system which might refresh and reflect the current scientific concepts of neuropsychopharmacology.

High H1-affinity antidepressants and risk of metabolic syndrome in bipolar disorder

“…Therefore, we suggest that clinicians look at medications' pharmacodynamic profile more than merely at the class before deciding which treatment is more appropriate for a specific patient, in order to prevent the occurrence of metabolic syndrome. In a recent paper, several opinion leaders in the field of clinical psychopharmacology state that, albeit classification should help the clinician in making the correct decision, ultimately leading to improved adherence, "current psychiatric drug classification fails to serve any of these purposes" (Zohar et al 2014). The authors conclude that an updated nomenclature, based on current knowledge on neurotransmitter function, receptor affinities, and side effects, should be adopted for psychotropics.…”

Emerging mechanisms and treatments for depression beyond SSRIs and SNRIs

“…see selective peptide receptor targets discussed in Section 4). Hence, multitarget (2 targets) or multimodal (2 targets from different target classes [12]) approaches that involve additive or synergistic effects of selected biological targets may be an attractive strategy for refining and improving efficacy and/or tolerability of currently used antidepressants. These ideas have been extensively discussed in the literature by several research groups [13][14][15][16] and are an overarching theme for this section.…”

“…However, the strategy has obvious limitations due to the potential risk of drug-drug interactions, which may complicate achieving the right therapeutic levels, as well as the stigmatization associated with the use of antipsychotics in the treatment of MDD [12].…”

The serotonergic system in the neurobiology of depression: Relevance for novel antidepressants

“…However, a reworked nomenclature might prove very useful both for the clinician making an informed decision as well as the patient who may show better adherence regarding the pharmacological treatment. A recent initiative of four major colleges of neuropsychopharmacology proposed a new template comprising a multi-axial pharmacologically driven nomenclature (Zohar et al, 2014). The template proposes five axes (primary pharmacological target and relevant mechanism family reflecting the relevant neurotransmitter and mechanism, neurobiological activities, efficacy and major side effects and approved indications).…”