Antidepressants have always attracted controversy. The classification was first mentioned in the 1950s, during the clinical trials of drugs intended to treat tuberculosis. Prescription rates skyrocketed in the 1990s after the introduction of Prozac, a selective serotonin reuptake inhibitor (SSRI). Their effects and efficacy have been the subject of debate ever since.
In the midst of these debates, one trend has continued to lurk on the sidelines: antidepressants are increasingly being prescribed for off-label use.
Apart from depression, SSRIs are used in the treatment of an array of mental and even physical illnesses. Sertraline, for example, has been found to be more effective in treating anxiety in the short term compared to depression.
For patients taking them for off-label reasons, the label “antidepressant” can in itself be problematic. A qualitative study on this subject found that some patients attempt to “decouple” the medication from its association with depression, such as by describing it as a “low dose.” This introduces the risk that a person who might benefit from taking antidepressants will refuse to do so in order to avoid the perception that they are depressed.
Given the uncertainty surrounding the effects of antidepressants, renaming this poorly understood category of drugs should be considered. Doing so would not only provide a more accurate reflection of how they are prescribed, but it could also go some way towards removing the stigma associated with psychotropic drugs.
But what would we call them if not antidepressants? In 2014, the “neuroscience-based nomenclature” system was proposed. Rather than categorising psychotropic drugs based upon their effect on specific disorders, such as antipsychotics, the system instead labels them based upon the neurotransmitter/s that the drug targets and the mode of action through which this is achieved. The label “antidepressant” is erased in favour of more specific names, such as ‘serotonin reuptake inhibitors.’ Some existing classes, like tricyclic antidepressants, are divided into different categories such as ‘dopamine receptor antagonists.’
These subcategories are far more descriptive than the overarching term ‘antidepressant.’ This could assist practitioners in tailoring prescriptions to a patient’s symptoms. More importantly, it could also reduce the association between these drugs and specific disorders, which will ultimately prevent confusion and improve compliance with prescription regimens.
This system is by no means perfect and caution must be directed towards the major conflicts of interest among its proponents. Nonetheless, it represents a step in a more accurate direction.
It could be argued that erasing antidepressants as a category of drugs further entrenches the stigma it seeks to resolve, suggesting that the word depression is irrevocably tainted. Indeed, reclassification does not resolve the underlying problem at hand. Even though the ways in which mental health is publicly discussed has been improving, stigma can continue to manifest itself on an arguably more sinister and unmoderated level — within the confines of private relationships. It is not difficult to find people who minimise mental illnesses by declaring that they are overdiagnosed, or who proclaim that jogging is the panacea to any psychological discomfort.
While reclassifying antidepressants will not end the stigmatisation of mental illness, it presents an opportunity to reduce the negative perceptions patients often encounter, both internally and externally, when opting to take psychotropic medication.
If you are not convinced about the potential for reclassification to reduce social stigma, the glaring discrepancy between the term “antidepressant” and the reality of the drug’s broadening application still remains. It might be tough to rectify a misnomer which has endured since the ‘50s, but custom is no excuse for inaction.
