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Dr. Stahl is adjunct professor of psychiatry in the Department of Psychiatry at the University of California–San Diego in La Jolla.
Faculty Disclosures: Dr. Stahl has served as a consultant to Arena, Azur, Bionevia, BristolMyers Squibb, Eli Lilly, Endo, Forest, Jazz, Johnson
& Johnson, Labopharm, Lundbeck, Marinus, Neuronetics, Novartis, Noven, PamLab, Pfizer, Pierre Fabre, Sanofi, Sepracor, Servier, Shire, SK
Corporation, Solvay, Somaxon, Tetragenex, and Vanda; he has served on speaker’s bureaus for Pfizer and Wyeth; and has received grant
support from Forest, Johnson & Johnson, Novartis, Organon, PamLab, Pfizer, Sepracor, Shire, Takeda, Vanda, and Wyeth.
If you would like to comment on this column or submit a suggestion to Dr. Stahl for future columns, please e-mail vj@mblcommunications.com.
but not the anticholinergic, antiadrenergic, and The dilemma in drug classification is thus
antihistamine properties.1 clear and explains the movement toward mul-
A list of various psychotropic agents that can tifunctional pharmacologic drug categorization.
be considered multifunctional is given in Table To accentuate the timeliness of this paradigm
1. This includes much of the current armamen- shift in drug classifications, an entire issue of
tarium of psychopharmacology. Drug nomencla- a recent journal is dedicated to various multi-
ture is moving toward naming an agent based functional drugs in neurology and psychiatry. 4
upon all of its therapeutically linked pharmaco-
logic properties, and not by its clinical action
or actions. Thus, is a drug an antidepressant TABLE 2.
(old fashioned) or a serotonin selective reuptake
Future Multifunctional Psychotropic
inhibitor (SSRI) or an SNRI (multifunctional)?
Agents in the Pipeline
Some SSRIs have important secondary prop-
erties; so should they be called “not-so-selec- Pharmacologic Proposed
tive serotonin reuptake inhibitors”?1,2 Or should Agents Actions Clinical Actions
SSRIs and SNRIs be called anxiolytics, since
Triple Serotonin, Antidepressant plus
most of them are also approved for up to five reuptake norepinephrine,
different anxiety disorders? inhibitors and dopamine
Similarly, what is a mood stabilizer? An anti- transport
convulsant? Some anticonvulsants? Lithium? Or inhibitors
the atypical antipsychotics? Agomelatine M1 and M2 Antidepressant,
In fact, what is an atypical antipsychotic agonist, 5-HT2C hypnotic, anxiolytic
when all of them treat nonpsychotic mania antagonist plus
and some of them treat bipolar and unipolar Asenapine Atypical Antipsychotic,
depression as well?1,3 antipsychotic antimanic,
antidepressant plus
Iloperidone Atypical Antipsychotic,
TABLE 1. antipsychotic antimanic,
Seeing Various Psychotropic Agents in antidepressant plus
Clinical Practice From a Multifunctional Lurasidone Atypical Antipsychotic
Perspective antipsychotic antimanic
antidepressant
All TCAs Trazodone possible pro-
cognitive agent plus
Doxepin Mirtazapine
LuAA21004 Serotonin Antidepressant,
Clomipramine Atypical Antipsychotics reuptake inhibitor, anxiolytic plus
Others Risperidone 5-HT1A partial
agonist, 5-HT3
SNRIs Olanzapine antagonist
Venlafaxine Quetiapine LuAA24530 Triple reuptake Antidepressant,
inhibitor plus anxiolytic plus
Desvenlafaxine Ziprasidone
Cariprazine D3 preferring and Antipsychotic,
Duloxetine Clozapine D2 partial agonist antimanic,
Milnacipran Aripiprazole antidepressant plus