We need to revamp how we classify drugs, especially drugs used in mental health and psychiatry. There is so much talk about fighting stigma in mental health diseases and I think changing how we label these medications will help.
The most common classifications of medication in psychiatry include: antipsychotics, antidepressants, anti-anxiolytics and mood stabilizers. These names give a false sense that antipsychotics are only prescribed for psychosis, antidepressants are for depression, anti-anxiolytics are for anxiety and mood stabilizer is for people with mood lability.
In fact, many of these medications are used beyond these indications and so the way we classify them is misleading and outdated. Many antidepressants such as amitriptyline, duloxetine nowadays are used for neuropathic pain, to help with anxiety and in some cases, refractory migraine. Antipsychotics such as quetiapine or aripiprazole are increasingly used for resistant depression, in people with bipolar disorders and so it’s not only for people with psychosis. Likewise, mood stabilizers such as lithium can be used in refractory depression as part of augmentation therapy and many anti-seizure drugs such as carbamazepine or gabapentine are used to manage mood or neuropathic pain.
Many times I struggle to clearly explain how medications are used in different mental health conditions. It may be confusing to the patient when I explain the amitriptyline is for her migraine when all she can read from the internet is that it is an antidepressant. Or when I try to explain the antipsychotic is to help with mood when the outpour of internet knowledge points to psychosis or schizophrenia.
In fact, they are all neurochemical modulators. When we have different mental health conditions or other neurological conditions such as seizure, pain or migraine, there is an imbalance of neurochemicals in our brain such as serotonin, norepinephrine and dopamine. So all of these medications aim to restore some balances in the neurochemistry. I know this is a very simplified way of explaining how these medications work but it’s sufficient for day to day patient education.
So why don’t we just ditch our current classification and label all of them as neurochemical modulators. This broad term will allow health care professionals to provide specific information based on the patient’s individual clinical conditions or diagnosis. I think it will help to minimize the stigma and hopefully improve adherence.