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Re: TCA + Effexor Combo / Maximum Effexor Dosage

Posted by SLS on January 3, 2023, at 12:35:29

In reply to Re: TCA + Effexor Combo / Maximum Effexor Dosage Jay2112, posted by undopaminergic on January 3, 2023, at 10:58:09

> >
> > I think it is important to keep a very wide range of options in mind, consideration for individual variables. I think you are missing out on the use of atypical antipsychotics, and other mood stabilizers. In particular, risperidone with it's 5ht2a blockade. 5ht2a is implicated as the 'activating' serotonin receptor. It may be likely responsible for mania, and the activating suicidal responses to serotonin drugs, in particular the SSRI's.(https://pubmed.ncbi.nlm.nih.gov/11870006/) Clozapine also has a strong 5ht2a blockade/antagonism.
> >
>
> In fact, clozapine was the first so-called atypical antipsychotic, with a lower incidence of extrapyramidal side effects (including tardive dyskinesia) but due to its potentially lethal hematological adverse effects, there was a lot of effort to develop "workalikes" to replace it. It was thought that the high ratio of serotonin 5-HT2A antagonism was one of the main characteristics of an atypical antipsychotic, so a lot of them have been developed (eg. olanzapine and quetiapine are notable). However, amisulpride does not fit into this model, as it has an "atypical" profile but no affinity for 5-HT2A.
>
> -undopaminergic

I would say that olanzapine (Zyprexa) is the drug closest to clozapine (Clozaril).


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