Three Key Neurotransmitter Systems of Antidepressants Norepinephrine Dopamine Serotonine.

Three Key Neurotransmitter Systems

of Antidepressants

• Norepinephrine• Dopamine• Serotonine

NOREPINEPHRINE RECEPTORS

presynaptic alpha 2 autoreceptor

postsynaptic alpha 2

receptorpostsynaptic beta 1 receptor

alpha 1 receptor

5-19 Stahl S M, Essential Psychopharmacology (2000)

DOPAMINE RECEPTORS

presynaptic autorecptor

D1 D2 D3 D4 D5

dopamine transporter

5--33 Stahl S M, Essential Psychopharmacology (2000)

SEROTONIN RECEPTORS

alpha 2 hetero receptor

5HT1D autoreceptor

5HT1A

serotonin transporter

5HT2A5HT2C

5HT3 5HT45HTX

5HTY

5HTZ

5--36 Stahl S M, Essential Psychopharmacology (2000)

SSRI Pharmacological Profile

Powerful 5HT disinhibition in key passways• from midbrain raphe to prefrontal cortex• from midbrain raphe to basal ganglia• from midbrain raphe to limbic cortex and

hippocampus• from midbrain raphe to hypothalamus• from midbrain raphe to spinal cord

Serotonin Pathways

Raphe Nucleus

5--51 Stahl S M, Essential Psychopharmacology (2000)

5--52 Stahl S M, Essential Psychopharmacology (2000)

Frontal Cortex Mood

5--53 Stahl S M, Essential Psychopharmacology (2000)

Basal Ganglia OCDAkathisia/Agitation

5--54 Stahl S M, Essential Psychopharmacology (2000)

Limbic Anxiety

5--55 Stahl S M, Essential Psychopharmacology (2000)

Hypothalamus Appetite/bulimia

5--56 Stahl S M, Essential Psychopharmacology (2000)

Sleep Centers Insomnia

SEROTONIN RECEPTORS

alpha 2 hetero receptor

5HT1D autoreceptor

5HT1A

serotonin transporter

5HT2A5HT2C

5HT3 5HT45HTX

5HTY

5HTZ

5--36 Stahl S M, Essential Psychopharmacology (2000)

NOREPINEPHRINE RECEPTORS

presynaptic alpha 2 autoreceptor

postsynaptic alpha 2

receptorpostsynaptic beta 1 receptor

alpha 1 receptor

5-19 Stahl S M, Essential Psychopharmacology (2000)

serotonin neuron

presynaptic alpha 2 autoreceptor

postsynaptic alpha 2 hetero receptor

presynaptic alpha 2 autoreceptor alpha 1

receptor

norepinephrine neuron

5--48 Stahl S M, Essential Psychopharmacology (2000)

5HT accelerator

5HT brake

7-11 Stahl S M, Essential Psychopharmacology (2000)

5HT1A

anxiolyticanti- depressant

5HT2C

anxiolytic

weight gain

5HT2A anxiolyticsleep restoring

no sexual dysfunction

5HT3

no GI problems

no nausea

SRI

NRIM1

H1

TCA

6-27 Stahl S M, Essential Psychopharmacology (2000)

• 5-HT1A

• Antidepressant• Anxiolytic• Lowering temperature

SRI inserted

NRI inserted

depression lifts

6-28 6-29

Stahl S M, Essential Psychopharmacology (2000)

depression lifts

H1 inserted

M1 inserted

LAXATIVE

constipation

dry mouth

blurred vision

drowsiness

6-30 6-31

Stahl S M, Essential Psychopharmacology (2000)

weight gain

drowsiness

inserteddizziness

decreased blood pressure

6-32 Stahl S M, Essential Psychopharmacology (2000)