Ryan S. Sultan, MD

Neuroscience-Based Nomenclature (NbN)

Modernizing How We Name Psychiatric Medications

What is Neuroscience-Based Nomenclature (NbN)?

Neuroscience-based Nomenclature (NbN) is a revolutionary classification system that names psychiatric medications based on their pharmacology and mechanism of action—not the disorder they were first approved to treat.

Developed by an international task force of leading neuroscience organizations (including the European College of Neuropsychopharmacology, American College of Neuropsychopharmacology, and others), NbN provides a scientifically accurate, less stigmatizing, and more informative way to understand psychiatric medications.

Why Traditional Names Are Problematic

1. They're Outdated

Current psychotropic nomenclature is largely based on concepts from the 1960s and 1970s. "Antidepressants" don't bind to "depression receptors"—they block monoamine transporters. "Stimulants" don't just promote wakefulness—they modulate dopamine and norepinephrine systems.

2. They're Confusing for Patients

Real examples of patient confusion:

• "If you diagnosed my son with separation anxiety, why are you giving him an antidepressant?"
• "My daughter never slows down—the last thing she needs is a stimulant!"
• "You want to give my child with tics an antipsychotic? He's not psychotic!"

3. They're Stigmatizing

Names conflate diagnoses with treatments. Children on "antidepressants" for OCD may believe they're "depressed." The label "antipsychotic" implies psychosis, even when prescribed for autism irritability, tics, or mood disorders.

4. They Obscure Important Differences

Under current naming, bupropion, mirtazapine, duloxetine, and fluoxetine are all "antidepressants"—yet they vary wildly in mechanisms, side effects, and indications. When our naming fails to distinguish medicines, it's hard for patients to understand why one "antidepressant" might work after another has failed.

How NbN Works: The New System

11 Pharmacological Domains

Instead of disease-based names, NbN classifies medications by their neuroscience targets:

1. Acetylcholine - Memory, cognition, attention
2. Dopamine - Motivation, reward, movement, psychosis
3. GABA - Inhibition, anxiety, sleep
4. Glutamate - Excitation, learning, mood
5. Histamine - Wakefulness, appetite, allergies
6. Ion Channels - Neuronal excitability, seizures
7. Lithium - Enzymatic actions (unique category)
8. Melatonin - Circadian rhythm, sleep
9. Norepinephrine - Alertness, attention, arousal
10. Opioid - Pain, reward, addiction
11. Serotonin - Mood, anxiety, OCD, appetite

10 Modes of Action

NbN describes how medications work at the molecular level:

• Reuptake Inhibitors - Block transporters (SSRIs, SNRIs)
• Releasers - Promote neurotransmitter release (amphetamines)
• Receptor Agonists - Activate receptors
• Receptor Antagonists - Block receptors
• Receptor Partial Agonists - Partially activate receptors
• Enzyme Inhibitors - Block enzymes (MAOIs)
• Enzyme Modulators - Modify enzyme activity
• Ion Channel Modulators - Affect channels (anticonvulsants)
• Multimodal - Complex, multiple actions

Examples: Old Names vs. NbN

Benefits of NbN

For Patients & Families:

• Less Stigma - No longer labeled "psychotic" for taking medication for tics
• Better Understanding - Know what the medication actually does in the brain
• Clearer Conversations - "Let's target the dopamine system to help with your focus"
• More Trust - Understand why medications work differently despite similar old names

For Clinicians:

• Scientific Accuracy - Names reflect actual neuroscience
• Better Differentiation - Distinguish medications within a "class"
• Improved Teaching - Educate about brain systems, not just disease labels
• Logical Treatment Plans - "Your ADHD involves dopamine/norepinephrine, so we'll use medications that target those systems"

For Researchers & Educators:

• Standardized Language - Recognized by major journals and textbooks
• Up-to-Date - Living system that updates as science advances
• Global Adoption - International task force with worldwide implementation

Real Clinical Examples

Example 1: ADHD Treatment

Old Way: "We're going to give your child a stimulant for ADHD."
Parent's Concern: "But my child is already too active! Why would you stimulate him more?"

NbN Way: "ADHD involves problems with dopamine and norepinephrine systems in the brain that control attention and impulse control. We'll use a medication that blocks dopamine and norepinephrine transporters, which helps these systems work better."
Result: Parent understands the mechanism and the logic.

Example 2: Anxiety with SSRIs

Old Way: "I'm prescribing an antidepressant for your child's separation anxiety."
Parent's Concern: "But she's not depressed—she has anxiety!"

NbN Way: "I'm prescribing a serotonin reuptake inhibitor. Serotonin is a brain chemical involved in both mood and anxiety. This medication helps the serotonin system work more effectively, which reduces anxiety."
Result: Clear explanation that matches the diagnosis.

Example 3: Tics with "Antipsychotics"

Old Way: "I'm recommending an antipsychotic for your son's tics."
Parent's Reaction: "ANTIPSYCHOTIC?! My son is NOT psychotic!"

NbN Way: "I'm recommending a dopamine receptor antagonist. Tics involve overactivity in dopamine pathways. This medication gently blocks dopamine receptors to reduce the tics."
Result: No stigma, accurate science, logical connection.

The NbN Apps: Free Resources

Challenges & Considerations

Change Takes Time

Clinicians have used legacy nomenclature for decades. However, in clinical practice, the transition is easier than expected. Many discussions already reference neurotransmitter systems—NbN simply formalizes this approach.

Incomplete Knowledge

Our understanding of medication mechanisms remains incomplete. Lithium, for example, sits in its own category because its exact mechanism is uncertain. However, this is still better than lumping lithium with valproic acid and lamotrigine as "mood stabilizers" when their pharmacology is completely different.

Educational Adoption

NbN is already recognized by major journals, textbooks, and teaching programs. As more clinicians adopt it, the system will become standard practice.

Research & International Collaboration

The NbN system was developed by an international task force including:

• European College of Neuropsychopharmacology (ECNP)
• American College of Neuropsychopharmacology (ACNP)
• Asian College of Neuropsychopharmacology (AsCNP)
• International College of Neuropsychopharmacology (CINP)
• International Union of Basic and Clinical Pharmacology (IUPHAR)

Co-Authors on Dr. Sultan's JAACAP Publication:

• Christoph U. Correll, MD - Zucker Hillside Hospital/Northwell Health, 1,000+ publications, world expert in psychopharmacology
• Joseph Zohar, MD - Chaim Sheba Medical Center, Israel, leading neuropsychopharmacologist
• Gil Zalsman, MD - Columbia University & Tel Aviv University, child psychiatry researcher
• Jeremy Veenstra-VanderWeele, MD - Director, Division of Child & Adolescent Psychiatry, Columbia/NewYork-Presbyterian

Toronto Presentation (2018)

Dr. Sultan presented on Neuroscience-based Nomenclature at the Canadian Psychiatric Association (CPA) Continuing Professional Development Conference in Toronto (2018), sharing this revolutionary approach with Canadian psychiatrists and promoting international adoption.

Key Takeaways

Related Resources

ADHD Medication Information:

• ADHD Medications Guide - Dopamine & norepinephrine targeting medications
• Why We Don't Call ADHD Medications "Stimulants" - Expanded discussion
• Non-Stimulant ADHD Medications - Alternative treatment options
• Complete ADHD Guide - Comprehensive resource

Clinical Content:

• ADHD in Children - Parent education on medications
• Off-Label Antipsychotic Prescribing - Evidence-based practices
• ADHD Psychiatrist NYC - Clinical services

Research & Publications:

• View Full Publication Citation - JAACAP Letter to Editor
• Clinical Education Articles - Educational content
• Academic CV - Publications and teaching
• Teaching & Education - Psychopharmacology education

External Resources:

• Official NbN Website - Search medications, download apps
• JAACAP Publication (2018) - Full text