Psychotropic medications classification
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Traditional Psychotropic Medications Classification: Indication-Based Systems
Historically, psychotropic medications have been classified based on the primary clinical indication for which they were first used, such as "antidepressants," "antipsychotics," "anxiolytics," "mood stabilizers," "stimulants," and "hypnotics" 17810. This system, known as the Anatomical Therapeutic Chemical (ATC) classification, organizes drugs by the body system they affect and their broad clinical use . For example, antipsychotics are grouped together even though they may have different mechanisms of action and are used for a variety of conditions beyond psychosis, such as bipolar disorder and depression 18. Similarly, antidepressants are often prescribed for anxiety and other disorders, blurring the boundaries between categories 18.
Limitations of Indication-Based Classification
The indication-based approach has several drawbacks. It does not reflect the underlying pharmacological mechanisms of the drugs, leading to confusion among clinicians, patients, and caregivers 128. Many drugs have multiple therapeutic uses, and their classification by a single indication can be misleading and stigmatizing 237. Additionally, new drugs with novel mechanisms or multiple indications are difficult to classify within this system, and terms like "atypical antipsychotics" or "mood stabilizers" often group together medications with very different actions .
Neuroscience-Based Nomenclature (NbN): A Pharmacology-Driven Approach
To address these issues, an international taskforce developed the Neuroscience-Based Nomenclature (NbN), which classifies psychotropic drugs based on their pharmacological profile and mode of action rather than their clinical indication 1235910. NbN uses up-to-date scientific knowledge to describe drugs by the neurotransmitter systems they affect (such as serotonin, dopamine, acetylcholine, or GABA) and their specific mode of action (such as receptor antagonist, agonist, or reuptake inhibitor) 125910. For example, instead of calling olanzapine an "antipsychotic," NbN describes it as a "D2, 5HT2 receptor antagonist" .
Multi-Dimensional Classification: Beyond Pharmacology
NbN also incorporates additional dimensions for each drug, including:
- Approved clinical indications
- Efficacy and common side effects
- Practical notes (such as drug interactions and metabolic issues)
- Neurobiological effects observed in laboratory studies 25910
This multi-layered approach provides clinicians with a clearer understanding of each medication, supporting more rational and individualized prescribing decisions 259.
Benefits of the Neuroscience-Based Nomenclature
The NbN system reduces confusion, helps match medications to patient symptom profiles, and avoids the stigma associated with traditional labels 1235910. It is especially helpful for pediatric prescribing, where indication-based names can be particularly misleading . The NbN is regularly updated and is accessible through a free app, making it easy for clinicians and researchers to use the most current information 110.
Ongoing Challenges and Future Directions
While the NbN represents a significant improvement, the classification of psychotropic drugs remains complex due to overlapping effects and evolving scientific knowledge 46. Some experts suggest that a flexible, multi-faceted approach is still needed to fully capture the diversity of psychotropic medications 46.
Conclusion
The classification of psychotropic medications is shifting from traditional indication-based systems to a neuroscience-based, pharmacologically driven approach. The NbN provides a clearer, more accurate framework that reflects current scientific understanding, supports better clinical decision-making, and reduces confusion and stigma for patients and caregivers 123578910.
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