January 26, 2023

This video includes answers to five questions about Serotonin Modulators and is intended for psychiatrists and psychiatry residents.

Hi everyone today we are going to talk about serotonin modulators so this is a group of medicine that is relatively new so i’m going to start with a high-yield question for pride in board exams that can also help open our discussion today so question number one what is the most common comorbidity with depressive disorders and the answer is anxiety disorders in fact

Fifty-nine percent of patients who are suffering from depressive disorders also have some sort of anxiety comorbidity so if that’s the case how are we going to treat it can you think of a new medication that can be used for treatment of depression with comorbid anxiety and the answer to that one is velocity’ 8a a vibrate so how does realizer don’t work this is the

Mechanism of action of villas udon it’s a serotonin reuptake inhibitor and at the same time it’s a 5hd one a partial agonist now can you think of another medication that is also 5hd one a partial agonist yes buspirone so the way i like to think of vilasa doan is that it’s a ssri plus buspirone but in one pill so that’s how i like to think about it now keep in mind

That the eliza done is fda approved only for md d but because of its mechanism of action it can also be used in the treatment of comorbid anxiety okay now question number three name a medication for depression that can also improve cognitive function independent of its antidepressant effects in the answer to that question is 40 oxygen now how does 40 occitane aka

Treinta licks work this is the mechanism of action of virtuosity it’s a serotonin reuptake inhibitor it’s also a full agonist at 5h t1a and it’s an antagonist at 5h 2 3 and 587 actually one theory is that the wave or occitan improves cognitive function is through antagonism at 5h 2 3 and 587 ok now let’s go to our next question question number 4 can you name for

Antidepressants that can be suggested to patients who are concerned about sexual side-effects with antidepressants i know that you’re already thinking of one of them but we want to think of four so if you’ll like you can stop the video and see if you can think of anything else otherwise let’s go and start talking about it no the one that you guys were probably

Thinking of was bupropion now let’s analyze it a little bit together we know that the protein is relatively safe as far as sexual side effects is concerned but why is that now the idea is that theoretically what is causing the sexual side effects is serotonin reuptake inhibition before pion as you may remember is a dopamine and norepinephrine reuptake inhibitor

As a result it is not going to a block certain reuptake at any significant level so that’s why it is relatively safe with sexual side-effects now can you think of another commonly used antidepressant that does not block the reuptake of serotonin and the answer is mirtazapine now again born a private question what is the mechanism of action of mirtazapine it’s

An alpha 2 blocker yeah so what does that alpha 2 block it means is that if this is the synaptic cleft and these are the norepinephrine here when there is too much norepinephrine in the synaptic cleft some of these norepinephrine comes and sits on the pretty synaptic alpha 2 receptor now what this person optic alpha 2 receptor do is that it gives a message to

The neuron that hey there’s too much norepinephrine here you need to slow it down now imagine what will happen if we block this there’s no message anymore that there’s too much norepinephrine here so it’ll increase the amount of norepinephrine available in the synaptic cleft as you can see there is no serotonin reuptake inhibition here so we will not have a very

High risk of sexual side effects so that brings us to my tazza pain we will wrap up mirtazapine appropriate but we set for how about the other two the other two are two antidepressants that we just talked about today the laser don’t and forty occitane now if you remember these two did block the reuptake of serotonin so it is not the case that they don’t cause any

Sexual side-effects no they do but it’s at a lower rate than the other anti now why is that one of the theories is that 5-ht 1a has something to do with the sexual side-effects and if you remember these two both had effects on 5ht 1a receptors so theoretically that may be why these two medications have a lower risk of sexual side-effects compared to the rest of

The antidepressants in fact there was a recent study that looked at 400 patients who were switched from other antidepressants to either virtue occitane or acetyl pram and they showed that those who were switched to warty occitane had an improvement in sexual dysfunction that was treatment emergent i’m gonna put the reference for that study here as well so seems

Like these two can be options that you can consider if you have a patient who is concerned about sexual side effects with antidepressants so that brings us to question number five i thought that it might be helpful in question number five to just compare the mechanisms of action of the serotonin modulators that we talked about now a lot of times the medication

That is called a search on your modulator is for occitane only because of what you guys are gonna see here i’m trying something new i’m gonna put a table here and make a list of all of the medications as you can see in this table forty occitane not only effects serotonin has one or two sites but at many different sites so the idea is that this is a certainty

Modulator it affects many different receptors people do refer to trazadone and galasso down with names such as serotonin antagonist and reuptake inhibitor for trazadone and serotonin partial agonist and reuptake inhibitor fertilizer on that to me these are just very long and i like to simplify things so i just like to put all of them in the same group because

They affect serotonin in more than one way and that kind of helps me organize my thought and the way i think about these three medications so you can look at the table why is it important to know the mechanisms of action so one reason may be because they asked these questions in the exam the other reason may be because there are some clinical implications so for

Example as we talked about five-ish 2 3 & 5 87 antagonism for botox a teen is theorized to be the reason for its cognitive benefits we did talk about five-ish d1a and how it has been associated with sexual side effects and how the effects of war ii oxide hiddenville acid or non ferrous t1a may potentially be the reason that they have lower sexual side effects

That’s pretty much it i hope that you had a very good day and

Transcribed from video
Serotonin Modulators (Trazodone, Vilazodone, Vortioxetine) By Psychiatry 5 Things You Probably Did Not Know