We use medications for reasons that don’t match their names. That’s why some clinicians are turning to Neuroscience-Based Nomenclature (NbN)—a system that classifies meds by mechanism instead of indication.
“When I’m manic, I feel like I put on Superman’s vest.”
That’s how one patient explained why he didn’t want to stay on lithium.He wasn’t denying the crashes. He just wasn’t ready to give up the highs. Another described it differently: “If you take too much of it you're slightly underwater, but if you take too little you're floating three feet above the water.”
They’ve had terrible luck with sexual side effects. And you’re silently trying to recall which SSRI is "less bad" on GI issues. It’s not that you don’t know the data—it’s that it’s never all in one place.
How many times have you prescribed Abilify for depression and then stumbled over what to call it?
Do you say “antidepressant”? “Mood stabilizer”? Or do you tell the truth—“It’s an antipsychotic”—and watch your patient flinch? We’ve all had this moment. The treatment fits. The label doesn’t.
“I still have to tap 5 times before picking up my wrench—and after putting it down.”
“I think the pipe’s going to burst.” He’s a plumber. And he’s been fighting OCD for years. Multiple SSRIs. High doses. CBT with your most trusted colleague across town.
You have 15 minutes. And you’re not entirely sure. That’s exactly why we built this course: Mood Disorders in Pregnancy, Postpartum, and Breastfeeding – A Carlat Review Course Not to oversimplify the complexity. But to give you the frameworks to navigate it—with clarity, confidence, and care.
A guard leans in and asks while you’re reviewing med orders on the correctional unit. You glance at the chart. Bupropion 150 mg. That’s it. But in here, that’s not “bupropion.” It’s contraband. Currency. A known favorite on the prison barter circuit.
I told my patient to hold an ice cube until it melted. She looked at me like I'd lost my mind. But it worked better than three different medications.When we—as therapists, clinicians, or just as humans living day to day—have had a little too much of the demands of work, family, bills, we don't talk about distress tolerance skills. We talk about needing to chill out, go for a walk, play a game on our phone.
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