Clarify the language, remove the stigma: That’s one of the goals behind an initiative to change the way we refer to psychiatric drugs. Instead of referring to them in broad terms based on the mental illness they purportedly treat, there is a campaign to refer to them by their pharmacological action, in other words, what they actually do in the brain.
Referring to a drug by what it does in the body provides greater clarity for clinicians, reduces stigma, and hopefully improves patient outcomes.
Dr. Pierre Blier, the director of the mood disorders research unit at The Royal’s Institute of Mental Health Research, is a member of the international task force behind the movement to change the language behind the prescriptions, and one of the primary authors of a reference guide called “NbN: Neuroscience-based Nomenclature.” The publication is in its second print edition and is available electronically as a free app. (There are 140 medications currently in the database and it’s updated every six months.)
Blier points out that part of the challenge of naming drugs is that they often treat more than one health issue, and the same drug can work in the body in different ways, depending on the dose. Take Aspirin, for example. Someone might take two 500 mg tablets for a headache or in response to moderate pain, but Aspirin is also prescribed to prevent blood clots or heart attack, and in this case the dosage is very different. Individuals who take Aspirin for blood coagulation typically take an 81mg dose – a baby Aspirin.
“So should Aspirin be classified as an anti-coagulant or an analgesic?” asks Blier. “It partly depends on how much you take.”
Before the introduction of the new nomenclature, clinicians could find themselves prescribing antidepressants to someone with anxiety, or antipsychotics to someone with depression.
Imagine sitting in a doctor’s office, discussing your struggle with depression. What would it feel like to be handed a prescription for antipsychotics? It’s clearer – and probably more positive on the receiving end – to be prescribed a selective serotonin reuptake inhibitor.
“We give antidepressants to people who have pure anxiety disorder like panic attacks – people who are not depressed. And now, we give atypical antipsychotics to people with depression, who do not have psychosis,” says Blier. “It’s confusing for the patients and it’s misspeaking as well, especially in respect to the antipsychotics,” says Blier. He gives the example of Abilify, a medication used to treat psychosis. “If you treat psychosis, you have to give 20-30 mg per day. When you treat depression, you give 2-5 mg. So you’re not even engaging the same receptors.”
The NbN publication helps clinicians apply the correct name and make informed choices when prescribing medication. It includes information such as most likely side effects and drug interactions, recommended dosage, and approved indications. (In other words, whether a drug is approved to treat a particular illness.)
The first printed edition of NbN – published in 2014 – received the seal of approval from international colleges of neuropsychopharmacology and leading scientific journals but wasn’t endorsed by the American Psychiatric Association (APA) until July 2019. The APA is actively encouraging the inclusion of NbN terminology in scientific products such as technical documents and materials published in APA journals.
The APA also recommends pilot trials “aimed at determining whether NbN improves patient-physician communication, patient satisfaction, medication adherence, or metrics related to quality of care.”
Blier says the question of adherence is an important one to answer and agrees that further study is needed.
“We have to prove (adherence) but you can imagine that if you’re depressed and I send you home with an antipsychotic medication you may not be very tempted to continue to stay on it,” he says.
As for next steps, the members of the NbN task force are each sharing the APA endorsement with their home country so that word will spread. A French translation is also underway.
The hope, of course, is that the new language will take on the characteristics of a contagion, and spread from medical conferences, medical associations and medical journals, to psychiatrists, family physicians, clinicians, and eventually anyone who works in mental health.
“We’re really moving forward with this,” says Blier. “It’s a process.”
For more information go to nbn2r.com.