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Serotonergic Mechanisms as Targets for Existing and Novel Antipsychotics

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Current Antipsychotics

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 212))

Abstract

A variety of serotonin (5-HT) receptors, especially 5-HT2A, 5-HT1A, 5-HT6, 5-HT7, and 5-HT2C, have been postulated to contribute to the mechanism of action of atypical antipsychotic drugs (APDs), i.e., APDs which cause fewer extrapyramidal side effects (EPS) at clinically optimal doses, in contrast with typical APDs, which are more likely to cause EPS. This advantage, rarely disputed, has made such drugs the preferred treatment for schizophrenia and other indications for APDs. These 5-HT receptors are still of interest as components of novel multireceptor or stand-alone APDs, and potentially to remediate cognitive deficits in schizophrenia. Almost all currently available atypical APDs are 5-HT2A receptor inverse agonists, as well as dopamine (DA) D2 receptor antagonists or partial agonists. Amisulpride, an exceptional atypical APD, has 5-HT7 antagonism to complement its DA D2/3 antagonism. Some atypical APDs are also 5-HT1A partial agonists, 5-HT6, or 5-HT7 antagonists, or some combination of the above. 5-HT2C antagonism has been found to contribute to the metabolic side effects of some atypical APDs, whereas 5-HT2C agonists have potential as stand-alone APDs and/or cognitive enhancers. This review will provide an update of current preclinical and clinical evidence for the role of these five 5-HT receptors in the actions of current APDs and for the development of novel psychotropic drugs.

Conflicts of Interest

Conflicts of Interest. Grantee and Consultant: Dainippon Sumitomo, Eli Lilly, EnVivo, Janssen, Sunovion, Teva; Consultant: ACADIA, Alkermes, Bioline Rx, EnVivo, Jazz, Lundbeck, Merck, Novartis, Otsuka; Stock Holder: ACADIA, Astra-Zeneca

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Acknowledgments

Supported, in part, by donations from Mr. and Mrs. Robert Weisman and Mr. and Mrs. Edward Hintz.

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  1. Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, 303 East Chicago Ave, Chicago, IL, 60611, USA

    Herbert Y. Meltzer M.D.

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  1. Institut für Pharmakologie, Universität, Neuroscience Research, Abbott GmbH & Co. KG, Knollstraße, Ludwigshafen, 67061, Germany

    Gerhard Gross

  2. Dept. Psychiatry, University of California San Diego, Gilman Drive 9500, La Jolla, 92093-0804, California, USA

    Mark A. Geyer

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Meltzer, H.Y. (2012). Serotonergic Mechanisms as Targets for Existing and Novel Antipsychotics. In: Gross, G., Geyer, M. (eds) Current Antipsychotics. Handbook of Experimental Pharmacology, vol 212. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25761-2_4

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