Major overhaul of psychotropic drug terminology launched

BERLIN – Official representatives of the world’s major neuropsychopharmacology organizations have grabbed their shovels in order to bury the time-honored and familiar terminology for the psychotropic medication categories, including “antipsychotics,” “anxiolytics,” “antidepressants,” and “hypnotics.”

These descriptors have long outlived their usefulness and are headed for the scrap heap, according to members of an international task force that unveiled a new neuroscience-based drug terminology at the annual congress of the European College of Neuropsychopharmacology.

“Our psychiatric medication nomenclature is hopelessly outdated. It is 50 years old. We are stuck in the 1960s,” explained Dr. Joseph Zohar, chair of the Joint Task Force on Nomenclature.

The old nomenclature neither reflects current scientific knowledge nor provides clinicians with pharmacologic information useful in making informed treatment decisions. And it certainly doesn’t help patients understand their physician’s rationale in choosing a particular medication.

“We talk about antidepressants, but many times, we give them for anxiety. We talk about antipsychotics, but often prescribe them for depression or anxiety. So the situation we face on almost a daily basis is the anxious patient asking us, ‘Why are you giving me an antidepressant for my anxiety?’ And which is even worse: the depressed patient asking, ‘Is my condition so bad that you’re giving me an antipsychotic?’ This has negative implications for compliance,” observed Dr. Zohar, director of the Anxiety and Obsessive Compulsive Clinic at Sheba Medical Center in Tel Hashomer, Israel.

Likewise, the widely used term “second-generation antipsychotic” is problematic. It encompasses compounds with fundamentally different pharmacologies, and clinicians unaware of that can unwittingly use these agents inappropriately.

“The term ‘second-generation antipsychotic’ is a marketing term. It’s not science,” he asserted.

The task force has created a new nomenclature along the lines of what’s used for antihypertensive medications, where a drug’s class – be it angiotensin-converting enzyme inhibitor, calcium channel blocker, diuretic, or beta-blocker – describes its mechanism of action. That way, when it becomes necessary to add a second or third antihypertensive agent in order to adequately control a patient’s blood pressure, a physician can pick agents having different mechanisms of action to maximize effectiveness and minimize side effects. That’s how it should work in biologic psychiatry, too, Dr. Zohar continued.

The new neuroscience-based nomenclature template has four components. Axis 1 describes the drug’s pharmacologic target and mode of action; to date, there are 11 possible pharmacologic targets and 10 modes of action. Axis 2 describes the drug’s approved indications. Axis 3 summarizes the panel’s collective opinion on the drug’s efficacy, which may extend beyond the approved indications, as for example, with the tricyclic antidepressants, as well as the drug’s major side effects. And Axis 4, which will mainly be of interest to neuroscientists rather than clinicians and patients, details the drug’s neurobiology. Take, for example, flurazepam (Dalmane). It’s often called an anxiolytic. That’s going to change, said task force member Dr. David J. Nutt, professor and head of the center for neuropsychopharmacology at Hammersmith Hospital, London.

“We wouldn’t any longer say ‘flurazepam is an anxiolytic.’ What we’d say is ‘flurazepam is one treatment for anxiety, and it works through being a positive allosteric modulator at the GABA-A receptor,’ ” he explained.

The task force comprises representatives from the ECNP, the American College of Neuropsychopharmacology (ACNP), the Asian College of Neuropsychopharmacology, the International College of Neuropsychopharmacology, and the International Union of Basic and Clinical Pharmacology.

The launch of the new nomenclature at the ACNP meeting was accompanied by release of the NbNomenclature app, which details the new terminology for 108 psychotropic drugs and is downloadable free at the App Store and Google Play. A paperback book covering the same material is also available.

Brandishing the book, Dr. Zohar declared, “We want this to be the DSM-5 of psychopharmacology.” That drew a wince from Dr. David J. Kupfer, the ACNP representative on the task force. As chair of the American Psychiatric Association’s task force for DSM-5, he had requested feedback as that controversial update took shape and wound up getting 14,000 responses, many quite critical. He’s not expecting anything of the sort in response to the proposed neuroscience-based drug nomenclature.

“It’s very clear that clinicians want this,” the psychiatrist said. “I think the scientific response will be very positive.”

The task force does, however, want the new nomenclature to be user friendly. Feedback is welcomed. The panel plans to meet at least once every 6 months to review outside comments and make thoughtful changes to the app, he added.

“Five years ago, when we started out, the idea of bringing international organizations together to work on a project like this seemed like Mission Impossible,” recalled Dr. Kupfer, professor of psychiatry at the University of Pittsburgh. “But now we’ve got a book and an app. We’ve accomplished phase 1 and have begun phase 2 of the implementation strategy.”

This next phase involves task force members holding meetings with editors of the major North American and European psychiatry and neuroscience journals in order to get their buy-in.

“We’re asking them to write an editorial commentary about the need for this new nomenclature. And we’ll ask them to develop a fairly uniform instruction for authors. Our target date is that by May 15, 2015 – while the APA is meeting in Toronto – the nomenclature will be adopted in manuscripts submitted to the journals, although maybe for a while the currently used terms will be in parentheses,” he said.

In the spring, the task force plans to reach out to the major psychiatric organizations with educational efforts. Also next spring, discussions will be held with the Food and Drug Administration, World Health Organization, and other regulatory bodies.

Further down the line, with a 3- to 5-year time horizon, the panel and its supporting organizations hope to get the new nomenclature introduced in textbooks and in the educational protocols used for medical students and psychiatry residents. They’ll also be meeting with the editors of the major nonpsychiatric medical journals as well as reaching out to leaders in primary care medicine.

“This is going to be an ongoing process,” Dr. Kupfer said. We’ll be educating a variety of different stakeholders, and that’s going to take time.”

Panelists said the new nomenclature won’t be used to rank medications or create clinical guidelines. However, the app can display all of the medications having a given efficacy and/or pharmacologic target.

Dr. Nutt said feedback from the pharmaceutical industry has been positive so far.

“We now meet with companies having compounds in phase 2 or 3 testing to discuss what their drug should be called. We think this is going to cut through a lot of the silliness and stupidity we’ve had over the last few decades,” he explained.

For example, companies developing new medications that target a specific aspect of schizophrenia, be it positive symptoms, negative symptoms, or cognitive symptoms, are well aware that under the traditional regulatory standards, their new agent would be classified as an antipsychotic. That means their drug would automatically get a black box warning label, even if its pharmacology is completely different from schizophrenia drugs that have been associated with serious side effects. The companies want to avoid that black box when it’s not warranted, and they’re starting to recognize that the new neuroscience-based nomenclature can be helpful in this regard, according to Dr. Nutt.

Dr. Eduard Vieta, chair of the ECNP communication committee, noted that pushing for the new nomenclature program represents a major commitment by the organization. The new terminology will ultimately change the way clinicians and their patients think about the drugs they use.

“There is a lot of important science being presented at this conference, but this nomenclature project is clearly the biggest news at the meeting,” observed Dr. Vieta, professor of psychiatry at the University of Barcelona.

The presenters reported having no financial relationships relevant to the nomenclature project.

[email protected]

BERLIN – Official representatives of the world’s major neuropsychopharmacology organizations have grabbed their shovels in order to bury the time-honored and familiar terminology for the psychotropic medication categories, including “antipsychotics,” “anxiolytics,” “antidepressants,” and “hypnotics.”

These descriptors have long outlived their usefulness and are headed for the scrap heap, according to members of an international task force that unveiled a new neuroscience-based drug terminology at the annual congress of the European College of Neuropsychopharmacology.

“Our psychiatric medication nomenclature is hopelessly outdated. It is 50 years old. We are stuck in the 1960s,” explained Dr. Joseph Zohar, chair of the Joint Task Force on Nomenclature.

The old nomenclature neither reflects current scientific knowledge nor provides clinicians with pharmacologic information useful in making informed treatment decisions. And it certainly doesn’t help patients understand their physician’s rationale in choosing a particular medication.

“We talk about antidepressants, but many times, we give them for anxiety. We talk about antipsychotics, but often prescribe them for depression or anxiety. So the situation we face on almost a daily basis is the anxious patient asking us, ‘Why are you giving me an antidepressant for my anxiety?’ And which is even worse: the depressed patient asking, ‘Is my condition so bad that you’re giving me an antipsychotic?’ This has negative implications for compliance,” observed Dr. Zohar, director of the Anxiety and Obsessive Compulsive Clinic at Sheba Medical Center in Tel Hashomer, Israel.

Likewise, the widely used term “second-generation antipsychotic” is problematic. It encompasses compounds with fundamentally different pharmacologies, and clinicians unaware of that can unwittingly use these agents inappropriately.

“The term ‘second-generation antipsychotic’ is a marketing term. It’s not science,” he asserted.

The task force has created a new nomenclature along the lines of what’s used for antihypertensive medications, where a drug’s class – be it angiotensin-converting enzyme inhibitor, calcium channel blocker, diuretic, or beta-blocker – describes its mechanism of action. That way, when it becomes necessary to add a second or third antihypertensive agent in order to adequately control a patient’s blood pressure, a physician can pick agents having different mechanisms of action to maximize effectiveness and minimize side effects. That’s how it should work in biologic psychiatry, too, Dr. Zohar continued.

The new neuroscience-based nomenclature template has four components. Axis 1 describes the drug’s pharmacologic target and mode of action; to date, there are 11 possible pharmacologic targets and 10 modes of action. Axis 2 describes the drug’s approved indications. Axis 3 summarizes the panel’s collective opinion on the drug’s efficacy, which may extend beyond the approved indications, as for example, with the tricyclic antidepressants, as well as the drug’s major side effects. And Axis 4, which will mainly be of interest to neuroscientists rather than clinicians and patients, details the drug’s neurobiology. Take, for example, flurazepam (Dalmane). It’s often called an anxiolytic. That’s going to change, said task force member Dr. David J. Nutt, professor and head of the center for neuropsychopharmacology at Hammersmith Hospital, London.

“We wouldn’t any longer say ‘flurazepam is an anxiolytic.’ What we’d say is ‘flurazepam is one treatment for anxiety, and it works through being a positive allosteric modulator at the GABA-A receptor,’ ” he explained.

The task force comprises representatives from the ECNP, the American College of Neuropsychopharmacology (ACNP), the Asian College of Neuropsychopharmacology, the International College of Neuropsychopharmacology, and the International Union of Basic and Clinical Pharmacology.

The launch of the new nomenclature at the ACNP meeting was accompanied by release of the NbNomenclature app, which details the new terminology for 108 psychotropic drugs and is downloadable free at the App Store and Google Play. A paperback book covering the same material is also available.

Brandishing the book, Dr. Zohar declared, “We want this to be the DSM-5 of psychopharmacology.” That drew a wince from Dr. David J. Kupfer, the ACNP representative on the task force. As chair of the American Psychiatric Association’s task force for DSM-5, he had requested feedback as that controversial update took shape and wound up getting 14,000 responses, many quite critical. He’s not expecting anything of the sort in response to the proposed neuroscience-based drug nomenclature.

“It’s very clear that clinicians want this,” the psychiatrist said. “I think the scientific response will be very positive.”

The task force does, however, want the new nomenclature to be user friendly. Feedback is welcomed. The panel plans to meet at least once every 6 months to review outside comments and make thoughtful changes to the app, he added.

“Five years ago, when we started out, the idea of bringing international organizations together to work on a project like this seemed like Mission Impossible,” recalled Dr. Kupfer, professor of psychiatry at the University of Pittsburgh. “But now we’ve got a book and an app. We’ve accomplished phase 1 and have begun phase 2 of the implementation strategy.”

This next phase involves task force members holding meetings with editors of the major North American and European psychiatry and neuroscience journals in order to get their buy-in.

“We’re asking them to write an editorial commentary about the need for this new nomenclature. And we’ll ask them to develop a fairly uniform instruction for authors. Our target date is that by May 15, 2015 – while the APA is meeting in Toronto – the nomenclature will be adopted in manuscripts submitted to the journals, although maybe for a while the currently used terms will be in parentheses,” he said.

In the spring, the task force plans to reach out to the major psychiatric organizations with educational efforts. Also next spring, discussions will be held with the Food and Drug Administration, World Health Organization, and other regulatory bodies.

Further down the line, with a 3- to 5-year time horizon, the panel and its supporting organizations hope to get the new nomenclature introduced in textbooks and in the educational protocols used for medical students and psychiatry residents. They’ll also be meeting with the editors of the major nonpsychiatric medical journals as well as reaching out to leaders in primary care medicine.

“This is going to be an ongoing process,” Dr. Kupfer said. We’ll be educating a variety of different stakeholders, and that’s going to take time.”

Panelists said the new nomenclature won’t be used to rank medications or create clinical guidelines. However, the app can display all of the medications having a given efficacy and/or pharmacologic target.

Dr. Nutt said feedback from the pharmaceutical industry has been positive so far.

“We now meet with companies having compounds in phase 2 or 3 testing to discuss what their drug should be called. We think this is going to cut through a lot of the silliness and stupidity we’ve had over the last few decades,” he explained.

For example, companies developing new medications that target a specific aspect of schizophrenia, be it positive symptoms, negative symptoms, or cognitive symptoms, are well aware that under the traditional regulatory standards, their new agent would be classified as an antipsychotic. That means their drug would automatically get a black box warning label, even if its pharmacology is completely different from schizophrenia drugs that have been associated with serious side effects. The companies want to avoid that black box when it’s not warranted, and they’re starting to recognize that the new neuroscience-based nomenclature can be helpful in this regard, according to Dr. Nutt.

Dr. Eduard Vieta, chair of the ECNP communication committee, noted that pushing for the new nomenclature program represents a major commitment by the organization. The new terminology will ultimately change the way clinicians and their patients think about the drugs they use.

“There is a lot of important science being presented at this conference, but this nomenclature project is clearly the biggest news at the meeting,” observed Dr. Vieta, professor of psychiatry at the University of Barcelona.

The presenters reported having no financial relationships relevant to the nomenclature project.

[email protected]

BERLIN – Official representatives of the world’s major neuropsychopharmacology organizations have grabbed their shovels in order to bury the time-honored and familiar terminology for the psychotropic medication categories, including “antipsychotics,” “anxiolytics,” “antidepressants,” and “hypnotics.”

These descriptors have long outlived their usefulness and are headed for the scrap heap, according to members of an international task force that unveiled a new neuroscience-based drug terminology at the annual congress of the European College of Neuropsychopharmacology.

“Our psychiatric medication nomenclature is hopelessly outdated. It is 50 years old. We are stuck in the 1960s,” explained Dr. Joseph Zohar, chair of the Joint Task Force on Nomenclature.

The old nomenclature neither reflects current scientific knowledge nor provides clinicians with pharmacologic information useful in making informed treatment decisions. And it certainly doesn’t help patients understand their physician’s rationale in choosing a particular medication.

“We talk about antidepressants, but many times, we give them for anxiety. We talk about antipsychotics, but often prescribe them for depression or anxiety. So the situation we face on almost a daily basis is the anxious patient asking us, ‘Why are you giving me an antidepressant for my anxiety?’ And which is even worse: the depressed patient asking, ‘Is my condition so bad that you’re giving me an antipsychotic?’ This has negative implications for compliance,” observed Dr. Zohar, director of the Anxiety and Obsessive Compulsive Clinic at Sheba Medical Center in Tel Hashomer, Israel.

Likewise, the widely used term “second-generation antipsychotic” is problematic. It encompasses compounds with fundamentally different pharmacologies, and clinicians unaware of that can unwittingly use these agents inappropriately.

“The term ‘second-generation antipsychotic’ is a marketing term. It’s not science,” he asserted.

The task force has created a new nomenclature along the lines of what’s used for antihypertensive medications, where a drug’s class – be it angiotensin-converting enzyme inhibitor, calcium channel blocker, diuretic, or beta-blocker – describes its mechanism of action. That way, when it becomes necessary to add a second or third antihypertensive agent in order to adequately control a patient’s blood pressure, a physician can pick agents having different mechanisms of action to maximize effectiveness and minimize side effects. That’s how it should work in biologic psychiatry, too, Dr. Zohar continued.

The new neuroscience-based nomenclature template has four components. Axis 1 describes the drug’s pharmacologic target and mode of action; to date, there are 11 possible pharmacologic targets and 10 modes of action. Axis 2 describes the drug’s approved indications. Axis 3 summarizes the panel’s collective opinion on the drug’s efficacy, which may extend beyond the approved indications, as for example, with the tricyclic antidepressants, as well as the drug’s major side effects. And Axis 4, which will mainly be of interest to neuroscientists rather than clinicians and patients, details the drug’s neurobiology. Take, for example, flurazepam (Dalmane). It’s often called an anxiolytic. That’s going to change, said task force member Dr. David J. Nutt, professor and head of the center for neuropsychopharmacology at Hammersmith Hospital, London.

“We wouldn’t any longer say ‘flurazepam is an anxiolytic.’ What we’d say is ‘flurazepam is one treatment for anxiety, and it works through being a positive allosteric modulator at the GABA-A receptor,’ ” he explained.

The task force comprises representatives from the ECNP, the American College of Neuropsychopharmacology (ACNP), the Asian College of Neuropsychopharmacology, the International College of Neuropsychopharmacology, and the International Union of Basic and Clinical Pharmacology.

The launch of the new nomenclature at the ACNP meeting was accompanied by release of the NbNomenclature app, which details the new terminology for 108 psychotropic drugs and is downloadable free at the App Store and Google Play. A paperback book covering the same material is also available.

Brandishing the book, Dr. Zohar declared, “We want this to be the DSM-5 of psychopharmacology.” That drew a wince from Dr. David J. Kupfer, the ACNP representative on the task force. As chair of the American Psychiatric Association’s task force for DSM-5, he had requested feedback as that controversial update took shape and wound up getting 14,000 responses, many quite critical. He’s not expecting anything of the sort in response to the proposed neuroscience-based drug nomenclature.

“It’s very clear that clinicians want this,” the psychiatrist said. “I think the scientific response will be very positive.”

The task force does, however, want the new nomenclature to be user friendly. Feedback is welcomed. The panel plans to meet at least once every 6 months to review outside comments and make thoughtful changes to the app, he added.

“Five years ago, when we started out, the idea of bringing international organizations together to work on a project like this seemed like Mission Impossible,” recalled Dr. Kupfer, professor of psychiatry at the University of Pittsburgh. “But now we’ve got a book and an app. We’ve accomplished phase 1 and have begun phase 2 of the implementation strategy.”

This next phase involves task force members holding meetings with editors of the major North American and European psychiatry and neuroscience journals in order to get their buy-in.

“We’re asking them to write an editorial commentary about the need for this new nomenclature. And we’ll ask them to develop a fairly uniform instruction for authors. Our target date is that by May 15, 2015 – while the APA is meeting in Toronto – the nomenclature will be adopted in manuscripts submitted to the journals, although maybe for a while the currently used terms will be in parentheses,” he said.

In the spring, the task force plans to reach out to the major psychiatric organizations with educational efforts. Also next spring, discussions will be held with the Food and Drug Administration, World Health Organization, and other regulatory bodies.

Further down the line, with a 3- to 5-year time horizon, the panel and its supporting organizations hope to get the new nomenclature introduced in textbooks and in the educational protocols used for medical students and psychiatry residents. They’ll also be meeting with the editors of the major nonpsychiatric medical journals as well as reaching out to leaders in primary care medicine.

“This is going to be an ongoing process,” Dr. Kupfer said. We’ll be educating a variety of different stakeholders, and that’s going to take time.”

Panelists said the new nomenclature won’t be used to rank medications or create clinical guidelines. However, the app can display all of the medications having a given efficacy and/or pharmacologic target.

Dr. Nutt said feedback from the pharmaceutical industry has been positive so far.

“We now meet with companies having compounds in phase 2 or 3 testing to discuss what their drug should be called. We think this is going to cut through a lot of the silliness and stupidity we’ve had over the last few decades,” he explained.

For example, companies developing new medications that target a specific aspect of schizophrenia, be it positive symptoms, negative symptoms, or cognitive symptoms, are well aware that under the traditional regulatory standards, their new agent would be classified as an antipsychotic. That means their drug would automatically get a black box warning label, even if its pharmacology is completely different from schizophrenia drugs that have been associated with serious side effects. The companies want to avoid that black box when it’s not warranted, and they’re starting to recognize that the new neuroscience-based nomenclature can be helpful in this regard, according to Dr. Nutt.

Dr. Eduard Vieta, chair of the ECNP communication committee, noted that pushing for the new nomenclature program represents a major commitment by the organization. The new terminology will ultimately change the way clinicians and their patients think about the drugs they use.

“There is a lot of important science being presented at this conference, but this nomenclature project is clearly the biggest news at the meeting,” observed Dr. Vieta, professor of psychiatry at the University of Barcelona.

The presenters reported having no financial relationships relevant to the nomenclature project.

[email protected]