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Background to the Neuroscience-based nomenclature
Interview with Prof. Joseph Zohar, recorded at ECNP Congress 2016, Vienna
What was the need for a new Neuroscience-based nomenclature?
The need is that the indication based nomenclature is not working for the patient. Many times we give antidepressants for anxiety; actually, most times we give antidepressants, but actually for anxiety, and then the patient is telling you “Why are you giving me antidepressants while I am not depressed?”
The scenario is even worse if you give antipsychotics for depression “Is my condition so bad that you are giving me antipsychotics, doctor?” so it is confusing for the patient, it has consequence on the adherence, and it doesn’t give information for the doctors, so the classification doesn’t help the doctor to do the rational next pharmacological step.
Could you tell us the process behind developing the Neuroscience-based nomenclature (NbN)?
It is a really unique process. Five organisations joined together, organisations with specific expertise in neuropsychopharmacology, and this includes the ECNP, the European College of Neuropsychopharmacology, the ACNP, the American College of Neuropsychopharmacology, the CINP, the International College of Neuropsychopharmacology, and the Asian College of Neuropsychopharmacology, together with IUPHAR, the International Union of Pharmacologists. All of these organisations have been working now for seven years in order to develop this classification, this new naming for psychotropic.
What were some of the challenges?
Basically, the NbN, the major point about this is that we move away from indication based to pharmacologically driven, so we don’t talk any more about antidepressants, but we talk about medication that affects specific pharmacological domains. Basically, it is based on the pharmacological domain and the mechanism of action of medication and this is the driving force. It enriches the language that we can talk about medication since now we have 11 types of pharmacological domains and 11 types of mechanism of action. The language now is a combination between any type of pharmacological domain and any time of mode of action, enriching our language in this regard.
How does the app work?
The app is, basically what we did, we did a book which we published in Cambridge Press a year ago, and then what we did, we thought it might be much better to have it in your pocket, so we developed an app. The app contains all the data in the book, but it is much more sophisticated. There is a very clever search engine in the app and you can, let’s say, look at all the medication that we have approved for OCD, let’s say. You can push and get all the medication that was approved for OCD.
Let’s say if you have a patient who suffers from depression, got serotonergic medication, and developed sexual side effects and the patient is coming to you and saying “I don’t want to take the medication anymore because of the sexual side effects”, so you can, using the app, look at medication with no adrenergic mechanism of action and that is approved for depression, and then you can look for sexual side effects and choose medication that is approved for depression that works versus no other adrenergic mechanism and has less sexual side effects. The app helps you to fine-tune, to direct, to adjust a medication according to the specific needs of the patient.
How has NbN been received in the community?
Basically, when we presented the vast majority of our colleagues say “Of course, this is what is needed. It makes sense. The medication is about pharmacology, so the classification, the naming should be about pharmacology” and they don’t like the feeling that they have so far that part of the classification was derived by marketing, like, what is the meaning of second generation antipsychotic? Second generation means that it is late, but nobody claimed that being late is better, so basically, it is very well received and secondly, the app helps the clinician to select the right medication from all the possible compounds. It helps them to use the data that is in the app to find and adjust and make the next, or first pharmacological step, in a rational way.
What are the next steps?
It was launched in May 2016. So far, about 20 journals accept, scientific journals – you know, journals that are leaders in psychopharmacology, accept the nomenclature, the NBN, there are editorials about this, so in the future we think that many journals, on top of the 20 that already accepted this, are going to use it and we think we would like to develop and that people are going to use it more.
Currently, we are working on a paediatric edition, so doing the same thing, but for children in other lessons, and we are planning to expand it also to other neurological disorders or disorders that are related to the brain. This is what we are busy doing now.
What is your take-home message?
My take-home message is that I encourage doctors to download the app, to use it, to learn more about it and see the advantage that this app and the new classification, the neuroscience based nomenclature, the new classification, helps them to take more informed choices while they are doing the next pharmacological step and how, talking with this language, using this language helps the patient and the family to understand why you are giving this type of medication. Instead of I am giving antipsychotics to depressed patients, the language that we are using is “On top of the serotonergic medication I am recruiting also the dopaminergic system to help you with your depression”, so changing the language, I think, has a lot of impact on the patient adherence, patient understanding and also regarding the stigma of the medication.