Recently, a patient’s mom asked me why I was prescribing an antidepressant, fluoxetine (the generic form of Prozac), for her son’s anxiety disorder. Jeremy had started on this medication in the past few weeks. When I first prescribed it, I carefully outlined the target symptom of anxiety and explained how the medicine would help treat the anxiety through the serotonin system.
Since starting the medicine, Jeremy’s anxiety levels were declining – he was getting better. But mom became concerned when her own mother and some friends of hers asked her why the doctor prescribed an antidepressant for anxiety. They thought he should also be on something “for his anxiety” – an anxiolytic.
We had a long discussion about this that cleared up the confusion. Mom felt comfortable with the explanation. But this is a conversation that I frequently have, in one form or another, with patients and families. The problem is that the names we give the various classes of medications can be misleading. The so-called “anti-depressants,” for example, are used to treat a wide range of disorders and symptoms, including anxiety.
This morning I watched a highlight video of some senior experts from the European College of Neuropsychopharmacology who were summarizing the findings of their meeting in Paris this month. One of the most interesting discussions came from Doctor Joseph Zohar from Tel Aviv who described an effort among many of the world’s researchers and clinicians in this area to develop a new language or “nomenclature” for psychiatric medications.
The group would like the formal and casual names of medications to focus first and foremost on the mechanism of action; for example, describing a medicine Prozac as a serotonin reuptake inhibitor rather than simply as “antidepressant.” A medicine such as Abilify, which is routinely referred to as an “antipsychotic,” would be more accurately described as a “partial dopamine D2 receptor agonist, partial serotonin 5HT1A agonist and serotonin 5HT2A antagonist.”
That’s quite a mouthful and obviously not something the press and the general public is likely to adopt. But the idea of naming medications according to their mechanism of action instead of the diagnosis they are typically used to treat is a step in the right direction.
The Congress actually would like to expand the naming process to a “multi-axial” or categorical system, something like the following:
- Axis 1: Mechanism of action in the brain.
- Axis II: Descriptor of the neurological systems the medication affects; that is, which brain circuits are affected.
- Axis III: Actual behaviors and activities affected, such as sleep or memory or cognition.
- Axis IV: The diagnoses that the medicine is used for.
Such a system is quite complex. Even the first Axis is far more complex than simply saying “antipsychotic.” Certainly we would need some shorthand terms to use in our conversations. Yet the idea of shifting our focus to the mechanism of action rather than an inaccurate general term is actually important at many levels, not the least of which is emphasizing the brain science behind psychiatry.
Changing language in a planned way is a significant challenge – mental health professionals and perhaps more importantly, the media, would need to adopt the new language and use it consistently and daily for it to become accepted and established.
But I welcome anything that moves us in the direction of better and clearer language and conversations about mental illness and its treatment, and I think this is an interesting approach and one worth serious discussion by caregivers and consumers alike.
Photo by Jessica Ojeda, available under a Creative Commons attribution license.