Guest Editorial

Neuroscience-based Nomenclature: Classifying psychotropics by mechanism of action rather than indication

Stephen M. Stahl, MD, PhD An important new initiative to Table 1 reclassify psychiatric medications is 11 Pharmacological domains underway. Currently, psychotropic Acetylcholine drugs are named primarily for their Dopamine clinical use, usually as a member of GABA Glutamate NbN renames 1 of 6 classes: antipsychotic, anti‑ Histamine depressant, mood stabilizer, stimu‑ Ion channel the >100 known lant, anxiolytic, and hypnotic.1,2 Melatonin psychotropic drugs by Norepinephrine This naming system creates confusion Opioid 1 of the 11 principle because so-called antidepressants com- Orexin pharmacological monly are used as anxiolytics, anti- Serotonin psychotics increasingly are used as domains and 9 modes antidepressants, and so on.1,2 of action Vocabulary based on clinical indica- tions also leads to difficulty in classify- oping an alternative naming system that ing new agents, especially those with is increasingly being accepted by the novel mechanisms of action or clinical major experts and journals throughout uses. Therefore, there is a need to make the world, called Neuroscience-based 3-5 References the names of psychotropic drugs more Nomenclature (NbN). 1. Nutt DJ. Beyond psychoanaleptics - rational and scientifically based, rather can we improve antidepressant drug nomenclature? J Psychopharmacol. than indication-based. A task force of So, what is NbN? 2009;23(4):343-345. experts from major psychopharmacol- First and foremost, NbN renames the 2. Stahl SM. Classifying psychotropic drugs by mode of action not by target disorders. ogy societies around the world is devel- >100 known psychotropic drugs by CNS Spectr. 2013;18(3):113-117. 1 of the 11 principle pharmacologi- 3. Zohar J, Stahl S, Moller HJ, et al. Dr. Stahl is Adjunct Professor of Psychiatry, University A review of the current nomenclature for cal domains that include well-known psychotropic agents and an introduction of California San Diego, San Diego, California, and Chair, to the Neuroscience-based Nomenclature. Neuroscience Education Institute, Carlsbad, California, terms such as serotonin dopamine, ace- Eur Neuropsychopharmacol. 2015; and a Member of the Current Psychiatry Editorial Board. 25(12):2318-2325. tylcholine, and GABA (Table 1). Also Disclosure 4. Zohar J, Stahl S, Moller HJ, et al. Neuroscience based nomenclature. Members of the task force, including the author of this included in NbN are 9 familiar modes Cambridge, United Kingdom: Cambridge editorial, and their organizations have not received financial of action, such as agonist, antagonist, University Press; 2014:254. compensation for their contribution. Costs for publication of the reuptake inhibitor, and enzyme inhibi- 5. Neuroscience-based nomenclature. book and development/update of the app have been paid for http://nbnomenclature.org. Accessed by the European College of Neuropsychopharmacology. tors (Table 2, page 16).3-5 April 12, 2017. continued Current Psychiatry Vol. 16, No. 5 15 Guest Editorial

Editorial Staff Table 2 paper. To make all new papers search- EDITOR Erica Vonderheid 9 Modes of action able by NbN terminology, the NbN of SENIOR EDITOR Patrice Weeks the drugs that the paper covers should ASSISTANT EDITOR Jason Orszt Enzyme inhibitor WEB ASSISTANTS be added to the keywords of the paper. Tyler Mundhenk, Kathryn Wighton Enzyme modulator Ion channel blocker The new keywords will include those Art & Production Staff Neurotransmitters releaser relevant 11 pharmacological domains CREATIVE DIRECTOR Mary Ellen Niatas and 9 modes of action of the drugs dis- ART DIRECTOR Pat Fopma Positive allosteric modulator DIRECTOR, JOURNAL MANUFACTURING Receptor agonist cussed in the paper, which will make Michael Wendt Receptor antagonist the process easier for authors and read- PRODUCTION MANAGER Donna Pituras Receptor partial agonist ers searching for drugs in our publica- Publishing Staff Reuptake inhibitor PUBLISHER Sharon J. Spector tions. To “translate” between old and DIGITAL ACCOUNT MANAGER new nomenclature, the easiest and rec- Reinaldo Valdivia SENIOR DIRECTOR OF SALES ommended way is to use the free NbN Tim LaPella NbN has 4 additional dimensions or app, which is available on the project’s CONFERENCE MARKETING MANAGER 3-5 Kathleen Wenzler layers : Web site (http://nbnomenclature.org), • The first layer enumerates the offi- as well as Google Play and iTunes. We Editor-in-Chief Emeritus James Randolph Hillard, MD cial indications as recognized by the reg- recommend that journal editors include Frontline Medical Communications ulatory agencies (ie, the FDA and other in their author instructions a link to the CHAIRMAN Stephen Stoneburn government organizations). glossary that illustrates NbN in practice PRESIDENT, DIGITAL & CFO Douglas E. Grose • The second layer states efficacy based (http://nbnomenclature.org/authors). PRESIDENT/CEO Alan J. Imhoff on randomized controlled trials or sub- PRESIDENT, CUSTOM SOLUTIONS JoAnn Wahl stantial, evidence-based clinical data, as What is the current status? SENIOR VICE PRESIDENT, FINANCE Steven Resnick well as side effects (not the exhaustive Two international organizations endorse VICE PRESIDENT, OPERATIONS Jim Chicca list provided in manufacturers’ package NbN, and the chief editors of nearly VICE PRESIDENT, AUDIENCE DEVELOPMENT Donna Sickles inserts, but only the most common ones). 3 dozen scientific journals, includ- VICE PRESIDENT, CUSTOM PROGRAMS • The third layer is comprised of ing Current Psychiatry, support the Carol Nathan VICE PRESIDENT, CUSTOM SOLUTIONS practical notes, highlighting potentially development of this classification sys- Wendy Raupers important drug interactions, metabolic tem for eventual implementation within VICE PRESIDENT, eBUSINESS DEVELOPMENT Lee Schweizer issues, and specific warnings. the scientific literature. Presentations VICE PRESIDENT, HUMAN RESOURCES • The fourth section summarizes the at symposia at international meetings & FACILITY OPERATIONS Carolyn Caccavelli VICE PRESIDENT, MARKETING & CUSTOMER neurobiological effects in laboratory ani- also have taken place or are ongoing, ADVOCACY Jim McDonough mals and humans. including a scientific session at the 2016 VICE PRESIDENT, SALES Mike Guire VICE PRESIDENT, SOCIETY PARTNERS Specific dosages and titration regi- American Psychiatric Association (APA) Mark Branca mens are not provided because they annual meeting and another planned CORPORATE DIRECTOR, RESEARCH & COMMUNICATIONS Lori Raskin can vary among different countries, and for the Presidential Symposium at 2017 EDITORIAL DIRECTOR Karen J. Clemments NbN is intended for nomenclature and APA annual meeting; other presenta- Subscription Services: (800) 480-4851 classification, not as a prescribing guide. tions are scheduled at the American In affiliation with Global Academy for Medical Education, LLC College of Neuropsychopharmacology VICE PRESIDENT, MEDICAL EDUCATION How does it work in practice? in December 2017 and the European & CONFERENCES Sylvia H. Reitman, MBA VICE PRESIDENT, EVENTS David J. Small, MBA Major journals in the field have begun College of Neuropsychopharmacology adapting NbN for their published in September 2017. papers and Current Psychiatry is Clinicians should start adopting the joining them. Specifically, journals NbN for the psychotropic drugs they 7 Century Drive, Suite 302 Parsippany, NJ 07054 adapting NbN will require authors to prescribe every day. It is more scientific Tel: (973) 206-3434 clarify the meaning of terms they use for and consistent with the mechanism Fax: (973) 206-9378 www.frontlinemedcom.com drugs by defining as “antipsychotic,” of action than with a specific disorder for example, along with the NbN term because many psychotropic medica- Published through an educational partnership (eg, dopamine D2 antagonist) where tions have been found to be useful in with Saint Louis University the drug name first appears in the >1 psychiatric disorder.

Current Psychiatry 16 May 2017