Stahl Chapter 5: Antipsychotics Exam Prep 2023.

what do 5HT2C receptors do? {Ans: They're postsynaptic and regulate DA and NE release. Stimulation suppresses DA release and usually more in the mesolimbic system than the nigrostriatal pathway (making an antipsychotic without EPS). An agent that selectively agonizes these is vabacaserin. This may also cause wt loss (how locaserin works). Blocking 5HT2C stimulates DA and NE release in the PFC. This is good for cognitive sxs and antidepressant actions. Mirtazapine and agomelatine do this. The pines have potent 5HT2C antagonism (esp quetiapine and olanzapine) this is why quetiapine is often combined with fluoxetine to boost antidepressant actions in tx resistant BPAD. Fluoxetine is a potent 5HT2C antagonist which is why this is a good combo. Olanzapine + fluoxetine is also a good combo for the same reason. Quetiapine also blocks NET, so these 2 combined is great for depression to boost DA and NE in the PFC. Asenapine also is a potent 5HT2C antagonist so it could be a good antidepressant as well but the other SGAs bind relatively weak to 5HT2C. - all the pines (clozapine, olanzapine, quetiapine, asenapine) bind more potently to 5HT2C than to D2. All of the dones (risperidone, paliperidone, ziprasidone, iloperidone, lurasidone) have