SlideShare a Scribd company logo
SEROTONIN
Presentation by: Dr. B Ooha Susmita
Moderator: Dr. Satya Krishna Kumar
METABOLISM
Synthesis
[Rate limiting step]
Transporters
• VMAT2- storage
and release of 5-HT
• SERT- reuptake
after release
Termination
By:
1. Reuptake by SERT into the
presynaptic neuron or into a
glial cell
2. Degradation by MAO and
ALDH (more affinity for MAO-
A)
• End product- 5-indoleacetic
acid
Receptor Location Action
5-HT1
• 5-HT1A
• 5-HT1B
• 5-HT1D
• 5-HT1E
• 5-HT1F
Hippocampus, Amygdala, Cerebral cortex, Entorhinal
cortex, Striatum, Septum, Hypothalamus, Raphe nuclei,
Substantia nigra, Superior colliculus, Olfactory bulb
1. Inhibition of adenylyl cyclase
2. Opening of K+ channels
5-HT2
• 5-HT2A
• 5-HT2B
• 5-HT2C
Claustrum, Cerebral cortex, Striatum, Olfactory tubercle,
Nucleus accumbens, Choroid plexus, Globus pallidus,
Substantia nigra, Hypothalamus, Septum, Spinal cord
1. Stimulation phosphoinositol specific
phospholipase C
2. Closing of K+ channels
5-HT3 Hippocampus, Entorhinal cortex, Amygdala, Nucleus
accumbens, Trigeminal nerve, Motor nucleus of dorsal
vagus, Area postrema, Spinal cord
1. Serotonin-gated cation channel
5-HT4 Hippocampus, Striatum, Olfactory tubercle, Substantia
nigra
1. Stimulation of adenylyl cyclase
5-HT5
• 5-HT5A
• 5-HT5B
1. Inhibition of adenylyl cyclase
5-HT6 1. Stimulation of adenylyl cyclase
5-HT7 Cerebral cortex, Septum, Thalamus, Hypothalamus,
Amygdala, Superior colliculus
1. Stimulation of adenylyl cyclase
Functions
Central
• Regulation of sleep
• Regulation of appetite
• Regulation of Mood
• Locomotor functions
• Pain perception
• Vomiting
Peripheral
• Smooth muscle contraction
• Vasoconstriction
• Bronchoconstriction
• Uterine contractions
• Peristalsis
• Vomiting
• Platelet aggregation and hemostasis
• Inflammatory mediator
• Sensitisation of nociceptors
Serotonergic Sites in the Brain
• Major:
1. Median raphe nuclei
2. Dorsal raphe nuclei
• Minor:
1. Locus ceruleus
2. Area postrema
3. Interpeduncular area
Serotonergic Pathways
• Ascending pathway through
medial forebrain bundle to:
Limbic system
Striatum and thalamus
• Descending pathways to:
Medulla,
Cerebellum and
Spinal cord
Ascending pathway
• From median raphe nuclei to limbic system
• From dorsal raphe nuclei to thalamus and striatum
• Involved in regulation of mood, anxiety, sleep-wake cycle and feeding behaviour
• Also involved in execution of rhythmic motor movements
Descending pathway
• From raphe nuclei to spinal cord
• Implicated in the suppression of nociceptive pathways, which might account for
analgesic effects of some antidepressants
SEROTONIN IN
PSYCHIATRY
Depression
• Biogenic amine hypothesis of mood disorders- depression is associated with too little
serotonin and mania is associated with too much serotonin
• The hypothesis might not be entirely accurate, however, it has been supported by
data from clinical trials of SSRIs which have been very effective in the treatment of
depressive disorder
• Permissive hypothesis postulates that low levels of serotonin permit abnormal levels
of norepinephrine to cause depression or mania
Suicidal Behaviour
• Decreased levels of central serotonin is associated with
increased risk of suicidal behaviour
• Studies have found low levels of serotonin metabolites
in the CSF and lower concentration of reuptake sites
on the platelets of patients with suicidal impulses
• Post-mortem neurochemical studies have decreased
levels of serotonin or 5-HIAA in either the brainstem or
frontal cortex of suicide victims
• Post-mortem receptor studies have also found
significant changes in the presynaptic and
postsynaptic binding sites of victims.
Cumulative suicide risk during first year after
attempted suicide in patients with low versus
high CSF concentrations of 5-HIAA. (From
Nordstrom P, Samuelsson M, Asberg M, et al.
CSF concentrations 5-HIAA predicts suicide
risk after attempted suicide. Suicide Life
Threat Behav. 1994;24:1, with permission.)
Anxiety Disorders
• Different types of acute stress result in increased 5-HT turnover in the prefrontal
cortex, nucleus accumbens, amygdala and lateral hypothalamus
• Drugs with serotonergic action such as Fenfluramine and Meta-
Chlorophenylpiperazine increase anxiety levels in patients
• Serotonergic hallucinogens and stimulants- LSD and MDMA- have been associated
with the development of acute and chronic anxiety disorders in users
• Buspirone, a 5-HT1A agonist, has yielded results when used as an anxiolytic which also
suggests a relationship between serotonin and anxiety
Obsessive-Compulsive Disorder
• Serotonergic drugs more effective than others
• Data from many clinical drug trials supports the hypothesis that dysfunction in the
serotonergic system is involved in the psychopathology of OCD
• One study shows decreased levels of 5-HIAA in CSF after treatment with
Clomipramine
Schizophrenia
• Current hypotheses posit serotonin excess as a cause of both positive and negative
symptoms in schizophrenia.
• The robust serotonin antagonist activity of clozapine and other second-generation
antipsychotics, coupled with the effectiveness of clozapine to decrease positive
symptoms in chronic patients has contributed to the validity of this proposition.
Personality Disorders
• Serotonin produces a sense of general well-being in a person
• In relation to personality traits, serotonergic and dopaminergic systems have been
found to stimulate arousal mechanisms in people.
• Also, treatment with serotonergic drugs such as SSRIs has been found to induce
changes in character traits of a patient
Sleep Regulation
• Many studies support the role of serotonin in sleep regulation
• Prevention of serotonin production or destruction of raphe nuclei reduces sleep for a
considerable time
• In deficiency of L-Tryptophan (the precursor of serotonin), REM sleep is decreased
along with increased sleep latency and nocturnal awakenings which is correctable by
increasing dietary L-tryptophan
Body Dysmorphic Disorder
• The pathophysiology may involve serotonin because of:
1. High comorbidity with depressive disorders,
2. Higher-than-expected family history of mood disorders and obsessive-compulsive
disorder (OCD), and
3. Reported responsiveness of the condition to serotonin-specific drugs
Eating Disorders
• The implication is hypothesised due to serotonin’s involvement in regulation of
feeding behaviour and satiety in the hypothalamus
• SSRIs are an effective modality of treatment in cases of Bulimia Nervosa
Aggression
• Some studies have found decreased CSF levels of 5-HIAA in alcoholic with history of
violence.
Sexual Disorders
• Serotonin has an inverse relationship with dopamine
• Stimulation of 5-HT2 and 5-HT3 receptors decreases synaptic dopamine release and
this has been implicated in the etiology of sexual dysfunction.
• This is further supported by the side effect profile of SSRIs which includes erectile
dysfunction and decreased libido
Serotonin Syndrome
• In situations of increased plasma serotonin levels
either due to a combination of serotonergic drugs
or increased dietary intake of tryptophan
• Symptoms:
SEROTONIN IN
PHARMACOLOGY
Ondansetron
MAO-A
selective
MAO-B
selective
Non-selective
Moclobemide Selegiline Phenelzine
Clorgyline Rasagiline tranylcypromine
SNRI
• desvenlafaxine (Pristiq)
• duloxetine (Cymbalta)
• venlafaxine (Effexor, Effexor XR)
• levomilnacipran (Fetzima)
• milnacipran (Savella)
SSRI • Citalopram (Celexa)
• Escitalopram
(Lexapro, Cipralex)
• Paroxetine (Paxil,
Seroxat)
• Fluoxetine (Prozac)
• Fluvoxamine
(Luvox)
• Sertraline (Zoloft,
Lustral)
TCA
• Amitriptyline.
• Amoxapine.
• Desipramine
(Norpramin)
• Doxepin.
• Imipramine
(Tofranil)
• Nortriptyline
(Pamelor)
• Protriptyline
(Vivactil)
• Trimipramine
(Surmontil)
References
• Stephen Stahl Essential Psychopharmacology, 4th ed.
• Kaplan and Sadock’s Synopsis of Psychiatry, 11th ed.
• Thank you

More Related Content

What's hot

Serotonin
SerotoninSerotonin
Neuropeptides
NeuropeptidesNeuropeptides
Neuropeptides
Murugavel Veeramani
 
Antidepressants Part I
Antidepressants Part IAntidepressants Part I
Antidepressants Part I
Brian Piper
 
Anti psychotic drugs
Anti psychotic drugsAnti psychotic drugs
Anti psychotic drugs
DrShrey Bhatia
 
Selective Serotonin Reuptake Inhibitor
Selective Serotonin Reuptake Inhibitor Selective Serotonin Reuptake Inhibitor
Selective Serotonin Reuptake Inhibitor
sarangpan
 
Dopamine And Pathways
Dopamine And PathwaysDopamine And Pathways
Dopamine And Pathways
Prashant Mishra
 
Glutamate
GlutamateGlutamate
Glutamate
srinathkmc
 
Novel neurotransmitters by Dr.JagMohan Prajapati
Novel neurotransmitters by Dr.JagMohan Prajapati Novel neurotransmitters by Dr.JagMohan Prajapati
Novel neurotransmitters by Dr.JagMohan Prajapati
DR Jag Mohan Prajapati
 
Dopamine
DopamineDopamine
Dopamine
Sethu S
 
Glutamate and psychiatry
Glutamate and psychiatryGlutamate and psychiatry
Glutamate and psychiatry
احمد البحيري
 
Monoamine neurotransmitters
Monoamine neurotransmittersMonoamine neurotransmitters
Monoamine neurotransmitters
Raj Sahu
 
Neurotransmitters
NeurotransmittersNeurotransmitters
Neurotransmitters
Anant Rathi
 
Neurotransmitters- serotonin & dopamine by dr. rujul modi
Neurotransmitters- serotonin & dopamine by dr. rujul modiNeurotransmitters- serotonin & dopamine by dr. rujul modi
Neurotransmitters- serotonin & dopamine by dr. rujul modi
Rujul Modi
 
Serotonin
SerotoninSerotonin
Treatment Resistant Ocd
Treatment Resistant OcdTreatment Resistant Ocd
Treatment Resistant Ocd
ramkumar g s
 
Typical antipsychotics
Typical   antipsychoticsTypical   antipsychotics
Typical antipsychotics
Anant Rathi
 
Neuropsychiatric aspects of headache
Neuropsychiatric aspects of headacheNeuropsychiatric aspects of headache
Neuropsychiatric aspects of headache
JITHIN T JOSEPH
 
Negative symptoms of schizophrenia
Negative symptoms of schizophreniaNegative symptoms of schizophrenia
Negative symptoms of schizophrenia
Rajeev Ranjan
 
Pharmacological Management of Bipolar Disorder
Pharmacological Management of Bipolar DisorderPharmacological Management of Bipolar Disorder
Pharmacological Management of Bipolar Disorder
donthuraj
 
Theories of sz
Theories of szTheories of sz
Theories of sz
Parth Goyal
 

What's hot (20)

Serotonin
SerotoninSerotonin
Serotonin
 
Neuropeptides
NeuropeptidesNeuropeptides
Neuropeptides
 
Antidepressants Part I
Antidepressants Part IAntidepressants Part I
Antidepressants Part I
 
Anti psychotic drugs
Anti psychotic drugsAnti psychotic drugs
Anti psychotic drugs
 
Selective Serotonin Reuptake Inhibitor
Selective Serotonin Reuptake Inhibitor Selective Serotonin Reuptake Inhibitor
Selective Serotonin Reuptake Inhibitor
 
Dopamine And Pathways
Dopamine And PathwaysDopamine And Pathways
Dopamine And Pathways
 
Glutamate
GlutamateGlutamate
Glutamate
 
Novel neurotransmitters by Dr.JagMohan Prajapati
Novel neurotransmitters by Dr.JagMohan Prajapati Novel neurotransmitters by Dr.JagMohan Prajapati
Novel neurotransmitters by Dr.JagMohan Prajapati
 
Dopamine
DopamineDopamine
Dopamine
 
Glutamate and psychiatry
Glutamate and psychiatryGlutamate and psychiatry
Glutamate and psychiatry
 
Monoamine neurotransmitters
Monoamine neurotransmittersMonoamine neurotransmitters
Monoamine neurotransmitters
 
Neurotransmitters
NeurotransmittersNeurotransmitters
Neurotransmitters
 
Neurotransmitters- serotonin & dopamine by dr. rujul modi
Neurotransmitters- serotonin & dopamine by dr. rujul modiNeurotransmitters- serotonin & dopamine by dr. rujul modi
Neurotransmitters- serotonin & dopamine by dr. rujul modi
 
Serotonin
SerotoninSerotonin
Serotonin
 
Treatment Resistant Ocd
Treatment Resistant OcdTreatment Resistant Ocd
Treatment Resistant Ocd
 
Typical antipsychotics
Typical   antipsychoticsTypical   antipsychotics
Typical antipsychotics
 
Neuropsychiatric aspects of headache
Neuropsychiatric aspects of headacheNeuropsychiatric aspects of headache
Neuropsychiatric aspects of headache
 
Negative symptoms of schizophrenia
Negative symptoms of schizophreniaNegative symptoms of schizophrenia
Negative symptoms of schizophrenia
 
Pharmacological Management of Bipolar Disorder
Pharmacological Management of Bipolar DisorderPharmacological Management of Bipolar Disorder
Pharmacological Management of Bipolar Disorder
 
Theories of sz
Theories of szTheories of sz
Theories of sz
 

Similar to Serotonin

antidepressant drugs.pdf
antidepressant drugs.pdfantidepressant drugs.pdf
antidepressant drugs.pdf
AtiqChohan2
 
Neurobiology of depression
Neurobiology of depressionNeurobiology of depression
Neurobiology of depression
Priyash Jain
 
Neurochemical basis of mood disorders
Neurochemical basis of mood disordersNeurochemical basis of mood disorders
Neurochemical basis of mood disorders
Sreedevi Remanan
 
Pedagogy
PedagogyPedagogy
Serotonin pharmacology
Serotonin  pharmacologySerotonin  pharmacology
Serotonin pharmacology
AliLaith5230
 
Neurobiology and functional brain circuits in mood disorders
Neurobiology and functional brain circuits in mood disordersNeurobiology and functional brain circuits in mood disorders
Neurobiology and functional brain circuits in mood disorders
Suman Sajan
 
pharmacology of Antipsychotic Agents & Lithium.ppt
pharmacology of Antipsychotic Agents & Lithium.pptpharmacology of Antipsychotic Agents & Lithium.ppt
pharmacology of Antipsychotic Agents & Lithium.ppt
NorhanKhaled15
 
Hanipsych, biology of impluse control disorders
Hanipsych, biology of impluse control disordersHanipsych, biology of impluse control disorders
Hanipsych, biology of impluse control disorders
Hani Hamed
 
Hanipsych, invega
Hanipsych, invegaHanipsych, invega
Hanipsych, invega
Hani Hamed
 
PsychoNeuroEndocrinology_RRR.pptx
PsychoNeuroEndocrinology_RRR.pptxPsychoNeuroEndocrinology_RRR.pptx
PsychoNeuroEndocrinology_RRR.pptx
ASHISH KUMAR
 
Etiopathogenesis of bipolar disorder
Etiopathogenesis of bipolar disorderEtiopathogenesis of bipolar disorder
Etiopathogenesis of bipolar disorder
Udayan Majumder
 
neurotransmitters.pptx
neurotransmitters.pptxneurotransmitters.pptx
neurotransmitters.pptx
Nimish Savaliya
 
Serotonin syndrome
Serotonin syndromeSerotonin syndrome
Serotonin syndrome
Santhosh Kumar
 
Borderline Personality disorder.pptx
Borderline Personality disorder.pptxBorderline Personality disorder.pptx
Borderline Personality disorder.pptx
RobinBaghla
 
Neurotransmitters and their role
Neurotransmitters and their roleNeurotransmitters and their role
Neurotransmitters and their role
Mirthula Rani
 
Serotonin and migraine
Serotonin and migraineSerotonin and migraine
Serotonin and migraine
Ankita Bist
 
The hypothalamus
The hypothalamusThe hypothalamus
The hypothalamus
Uphar Gupta
 
Basal Ganglia.pptx
Basal Ganglia.pptxBasal Ganglia.pptx
Basal Ganglia.pptx
KokoLila
 
Hanipsych, serotonine and depression
Hanipsych, serotonine and depressionHanipsych, serotonine and depression
Hanipsych, serotonine and depression
Hani Hamed
 
Antidepressant pharmacology
Antidepressant pharmacology Antidepressant pharmacology
Antidepressant pharmacology
Ahmed Morgan
 

Similar to Serotonin (20)

antidepressant drugs.pdf
antidepressant drugs.pdfantidepressant drugs.pdf
antidepressant drugs.pdf
 
Neurobiology of depression
Neurobiology of depressionNeurobiology of depression
Neurobiology of depression
 
Neurochemical basis of mood disorders
Neurochemical basis of mood disordersNeurochemical basis of mood disorders
Neurochemical basis of mood disorders
 
Pedagogy
PedagogyPedagogy
Pedagogy
 
Serotonin pharmacology
Serotonin  pharmacologySerotonin  pharmacology
Serotonin pharmacology
 
Neurobiology and functional brain circuits in mood disorders
Neurobiology and functional brain circuits in mood disordersNeurobiology and functional brain circuits in mood disorders
Neurobiology and functional brain circuits in mood disorders
 
pharmacology of Antipsychotic Agents & Lithium.ppt
pharmacology of Antipsychotic Agents & Lithium.pptpharmacology of Antipsychotic Agents & Lithium.ppt
pharmacology of Antipsychotic Agents & Lithium.ppt
 
Hanipsych, biology of impluse control disorders
Hanipsych, biology of impluse control disordersHanipsych, biology of impluse control disorders
Hanipsych, biology of impluse control disorders
 
Hanipsych, invega
Hanipsych, invegaHanipsych, invega
Hanipsych, invega
 
PsychoNeuroEndocrinology_RRR.pptx
PsychoNeuroEndocrinology_RRR.pptxPsychoNeuroEndocrinology_RRR.pptx
PsychoNeuroEndocrinology_RRR.pptx
 
Etiopathogenesis of bipolar disorder
Etiopathogenesis of bipolar disorderEtiopathogenesis of bipolar disorder
Etiopathogenesis of bipolar disorder
 
neurotransmitters.pptx
neurotransmitters.pptxneurotransmitters.pptx
neurotransmitters.pptx
 
Serotonin syndrome
Serotonin syndromeSerotonin syndrome
Serotonin syndrome
 
Borderline Personality disorder.pptx
Borderline Personality disorder.pptxBorderline Personality disorder.pptx
Borderline Personality disorder.pptx
 
Neurotransmitters and their role
Neurotransmitters and their roleNeurotransmitters and their role
Neurotransmitters and their role
 
Serotonin and migraine
Serotonin and migraineSerotonin and migraine
Serotonin and migraine
 
The hypothalamus
The hypothalamusThe hypothalamus
The hypothalamus
 
Basal Ganglia.pptx
Basal Ganglia.pptxBasal Ganglia.pptx
Basal Ganglia.pptx
 
Hanipsych, serotonine and depression
Hanipsych, serotonine and depressionHanipsych, serotonine and depression
Hanipsych, serotonine and depression
 
Antidepressant pharmacology
Antidepressant pharmacology Antidepressant pharmacology
Antidepressant pharmacology
 

Recently uploaded

Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
MuskanShingari
 
Breast cancer: Post menopausal endocrine therapy
Breast cancer: Post menopausal endocrine therapyBreast cancer: Post menopausal endocrine therapy
Breast cancer: Post menopausal endocrine therapy
Dr. Sumit KUMAR
 
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and AntagonistPharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
Dr. Nikhilkumar Sakle
 
Helminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing studentsHelminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing students
RAJU B N
 
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
Université de Montréal
 
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International TravelersTravel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International Travelers
NX Healthcare
 
Microbiology & Parasitology Exercises Parts of the Microscope
Microbiology & Parasitology Exercises Parts of the MicroscopeMicrobiology & Parasitology Exercises Parts of the Microscope
Microbiology & Parasitology Exercises Parts of the Microscope
ThaShee2
 
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory projectNano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
SIVAVINAYAKPK
 
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticalsacne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
MuskanShingari
 
All about shoulder Joint ..
All about shoulder Joint .. All about shoulder Joint ..
All about shoulder Joint ..
Aswan University Hospital
 
Cervical Disc Arthroplasty ORSI 2024.pptx
Cervical Disc Arthroplasty ORSI 2024.pptxCervical Disc Arthroplasty ORSI 2024.pptx
Cervical Disc Arthroplasty ORSI 2024.pptx
LEFLOT Jean-Louis
 
Pharmacology of Prostaglandins, Thromboxanes and Leukotrienes
Pharmacology of Prostaglandins, Thromboxanes and LeukotrienesPharmacology of Prostaglandins, Thromboxanes and Leukotrienes
Pharmacology of Prostaglandins, Thromboxanes and Leukotrienes
Dr. Nikhilkumar Sakle
 
pharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdfpharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdf
KerlynIgnacio
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
Dr. Ahana Haroon
 
13. PROM premature rupture of membranes
13.  PROM premature rupture of membranes13.  PROM premature rupture of membranes
13. PROM premature rupture of membranes
TigistuMelak
 
Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1 Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1
Jyoti Bhaghasra
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
Chulalongkorn Allergy and Clinical Immunology Research Group
 
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
Donc Test
 
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.GawadHemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
NephroTube - Dr.Gawad
 
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga
 

Recently uploaded (20)

Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
 
Breast cancer: Post menopausal endocrine therapy
Breast cancer: Post menopausal endocrine therapyBreast cancer: Post menopausal endocrine therapy
Breast cancer: Post menopausal endocrine therapy
 
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and AntagonistPharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
 
Helminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing studentsHelminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing students
 
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
 
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International TravelersTravel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International Travelers
 
Microbiology & Parasitology Exercises Parts of the Microscope
Microbiology & Parasitology Exercises Parts of the MicroscopeMicrobiology & Parasitology Exercises Parts of the Microscope
Microbiology & Parasitology Exercises Parts of the Microscope
 
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory projectNano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
 
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticalsacne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
 
All about shoulder Joint ..
All about shoulder Joint .. All about shoulder Joint ..
All about shoulder Joint ..
 
Cervical Disc Arthroplasty ORSI 2024.pptx
Cervical Disc Arthroplasty ORSI 2024.pptxCervical Disc Arthroplasty ORSI 2024.pptx
Cervical Disc Arthroplasty ORSI 2024.pptx
 
Pharmacology of Prostaglandins, Thromboxanes and Leukotrienes
Pharmacology of Prostaglandins, Thromboxanes and LeukotrienesPharmacology of Prostaglandins, Thromboxanes and Leukotrienes
Pharmacology of Prostaglandins, Thromboxanes and Leukotrienes
 
pharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdfpharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdf
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
 
13. PROM premature rupture of membranes
13.  PROM premature rupture of membranes13.  PROM premature rupture of membranes
13. PROM premature rupture of membranes
 
Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1 Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
 
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
 
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.GawadHemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
 
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
 

Serotonin

  • 1. SEROTONIN Presentation by: Dr. B Ooha Susmita Moderator: Dr. Satya Krishna Kumar
  • 4. Transporters • VMAT2- storage and release of 5-HT • SERT- reuptake after release
  • 5. Termination By: 1. Reuptake by SERT into the presynaptic neuron or into a glial cell 2. Degradation by MAO and ALDH (more affinity for MAO- A) • End product- 5-indoleacetic acid
  • 6. Receptor Location Action 5-HT1 • 5-HT1A • 5-HT1B • 5-HT1D • 5-HT1E • 5-HT1F Hippocampus, Amygdala, Cerebral cortex, Entorhinal cortex, Striatum, Septum, Hypothalamus, Raphe nuclei, Substantia nigra, Superior colliculus, Olfactory bulb 1. Inhibition of adenylyl cyclase 2. Opening of K+ channels 5-HT2 • 5-HT2A • 5-HT2B • 5-HT2C Claustrum, Cerebral cortex, Striatum, Olfactory tubercle, Nucleus accumbens, Choroid plexus, Globus pallidus, Substantia nigra, Hypothalamus, Septum, Spinal cord 1. Stimulation phosphoinositol specific phospholipase C 2. Closing of K+ channels 5-HT3 Hippocampus, Entorhinal cortex, Amygdala, Nucleus accumbens, Trigeminal nerve, Motor nucleus of dorsal vagus, Area postrema, Spinal cord 1. Serotonin-gated cation channel 5-HT4 Hippocampus, Striatum, Olfactory tubercle, Substantia nigra 1. Stimulation of adenylyl cyclase 5-HT5 • 5-HT5A • 5-HT5B 1. Inhibition of adenylyl cyclase 5-HT6 1. Stimulation of adenylyl cyclase 5-HT7 Cerebral cortex, Septum, Thalamus, Hypothalamus, Amygdala, Superior colliculus 1. Stimulation of adenylyl cyclase
  • 7. Functions Central • Regulation of sleep • Regulation of appetite • Regulation of Mood • Locomotor functions • Pain perception • Vomiting Peripheral • Smooth muscle contraction • Vasoconstriction • Bronchoconstriction • Uterine contractions • Peristalsis • Vomiting • Platelet aggregation and hemostasis • Inflammatory mediator • Sensitisation of nociceptors
  • 8. Serotonergic Sites in the Brain • Major: 1. Median raphe nuclei 2. Dorsal raphe nuclei • Minor: 1. Locus ceruleus 2. Area postrema 3. Interpeduncular area
  • 9. Serotonergic Pathways • Ascending pathway through medial forebrain bundle to: Limbic system Striatum and thalamus • Descending pathways to: Medulla, Cerebellum and Spinal cord
  • 10. Ascending pathway • From median raphe nuclei to limbic system • From dorsal raphe nuclei to thalamus and striatum • Involved in regulation of mood, anxiety, sleep-wake cycle and feeding behaviour • Also involved in execution of rhythmic motor movements Descending pathway • From raphe nuclei to spinal cord • Implicated in the suppression of nociceptive pathways, which might account for analgesic effects of some antidepressants
  • 12. Depression • Biogenic amine hypothesis of mood disorders- depression is associated with too little serotonin and mania is associated with too much serotonin • The hypothesis might not be entirely accurate, however, it has been supported by data from clinical trials of SSRIs which have been very effective in the treatment of depressive disorder • Permissive hypothesis postulates that low levels of serotonin permit abnormal levels of norepinephrine to cause depression or mania
  • 13. Suicidal Behaviour • Decreased levels of central serotonin is associated with increased risk of suicidal behaviour • Studies have found low levels of serotonin metabolites in the CSF and lower concentration of reuptake sites on the platelets of patients with suicidal impulses • Post-mortem neurochemical studies have decreased levels of serotonin or 5-HIAA in either the brainstem or frontal cortex of suicide victims • Post-mortem receptor studies have also found significant changes in the presynaptic and postsynaptic binding sites of victims. Cumulative suicide risk during first year after attempted suicide in patients with low versus high CSF concentrations of 5-HIAA. (From Nordstrom P, Samuelsson M, Asberg M, et al. CSF concentrations 5-HIAA predicts suicide risk after attempted suicide. Suicide Life Threat Behav. 1994;24:1, with permission.)
  • 14. Anxiety Disorders • Different types of acute stress result in increased 5-HT turnover in the prefrontal cortex, nucleus accumbens, amygdala and lateral hypothalamus • Drugs with serotonergic action such as Fenfluramine and Meta- Chlorophenylpiperazine increase anxiety levels in patients • Serotonergic hallucinogens and stimulants- LSD and MDMA- have been associated with the development of acute and chronic anxiety disorders in users • Buspirone, a 5-HT1A agonist, has yielded results when used as an anxiolytic which also suggests a relationship between serotonin and anxiety
  • 15. Obsessive-Compulsive Disorder • Serotonergic drugs more effective than others • Data from many clinical drug trials supports the hypothesis that dysfunction in the serotonergic system is involved in the psychopathology of OCD • One study shows decreased levels of 5-HIAA in CSF after treatment with Clomipramine
  • 16. Schizophrenia • Current hypotheses posit serotonin excess as a cause of both positive and negative symptoms in schizophrenia. • The robust serotonin antagonist activity of clozapine and other second-generation antipsychotics, coupled with the effectiveness of clozapine to decrease positive symptoms in chronic patients has contributed to the validity of this proposition.
  • 17. Personality Disorders • Serotonin produces a sense of general well-being in a person • In relation to personality traits, serotonergic and dopaminergic systems have been found to stimulate arousal mechanisms in people. • Also, treatment with serotonergic drugs such as SSRIs has been found to induce changes in character traits of a patient
  • 18. Sleep Regulation • Many studies support the role of serotonin in sleep regulation • Prevention of serotonin production or destruction of raphe nuclei reduces sleep for a considerable time • In deficiency of L-Tryptophan (the precursor of serotonin), REM sleep is decreased along with increased sleep latency and nocturnal awakenings which is correctable by increasing dietary L-tryptophan
  • 19. Body Dysmorphic Disorder • The pathophysiology may involve serotonin because of: 1. High comorbidity with depressive disorders, 2. Higher-than-expected family history of mood disorders and obsessive-compulsive disorder (OCD), and 3. Reported responsiveness of the condition to serotonin-specific drugs
  • 20. Eating Disorders • The implication is hypothesised due to serotonin’s involvement in regulation of feeding behaviour and satiety in the hypothalamus • SSRIs are an effective modality of treatment in cases of Bulimia Nervosa Aggression • Some studies have found decreased CSF levels of 5-HIAA in alcoholic with history of violence.
  • 21. Sexual Disorders • Serotonin has an inverse relationship with dopamine • Stimulation of 5-HT2 and 5-HT3 receptors decreases synaptic dopamine release and this has been implicated in the etiology of sexual dysfunction. • This is further supported by the side effect profile of SSRIs which includes erectile dysfunction and decreased libido
  • 22. Serotonin Syndrome • In situations of increased plasma serotonin levels either due to a combination of serotonergic drugs or increased dietary intake of tryptophan • Symptoms:
  • 24.
  • 25.
  • 28. SNRI • desvenlafaxine (Pristiq) • duloxetine (Cymbalta) • venlafaxine (Effexor, Effexor XR) • levomilnacipran (Fetzima) • milnacipran (Savella)
  • 29. SSRI • Citalopram (Celexa) • Escitalopram (Lexapro, Cipralex) • Paroxetine (Paxil, Seroxat) • Fluoxetine (Prozac) • Fluvoxamine (Luvox) • Sertraline (Zoloft, Lustral)
  • 30. TCA • Amitriptyline. • Amoxapine. • Desipramine (Norpramin) • Doxepin. • Imipramine (Tofranil) • Nortriptyline (Pamelor) • Protriptyline (Vivactil) • Trimipramine (Surmontil)
  • 31. References • Stephen Stahl Essential Psychopharmacology, 4th ed. • Kaplan and Sadock’s Synopsis of Psychiatry, 11th ed. • Thank you

Editor's Notes

  1. Treatment: withdrawal of drug and supportive management with fluid replacement, cooling blankets, cyproheptadine, nitroglycerine, dantrolene bzds, anticonvulsants, mechanical ventilation and paralysing agents