anti-anxiety

antidepressant

mental retardation

Insomnia

Dizziness and headache

extrapyramidal reaction

Promote itching

gastrointestinal system

circulatory system

reproductive system

skeletal system

Buspirone→post-synaptic membrane 5-HT 1A receptor→promotes DA release in the ventromedial part of the prefrontal cortex

Improve sexual function

Increase alertness

QT interval prolongation

Anti-negative symptoms and cognitive impairment

Anti-mood disorder

Anti-extrapyramidal reaction

Both blocking 5-HT 2A receptors and stimulating 5-HT 1A receptors can increase DA energy, and their three-antibody effects are similar.

antidepressant

Anti-cognitive impairment

Decreased intestinal motility

reduced sexual inhibition

Blocks 5-HT recycling (dulled emotion) > Blocks NE recycling, SSRIs > SNRIs

SSRIs block 5-HT recycling from strong to weak: paroxetine > escitalopram > sertraline > fluoxetine > citalopram > fluvoxamine

Block NE recycling (increase power) > Block 5-HT recycling

SNRIs block NE recycling from strong to weak: reboxetine > milnacipran > duloxetine > venlafaxine > fluoxetine > sertraline > fluvoxamine > citalopram

Duloxetine increases NE energy → stimulates α1 receptors → hypervigilance →

Venlafaxine increases NE energy → (excessive) stimulation of brain beta receptors → (induced mania) antidepressant

The locus coeruleus-ventral tegmental part of the midbrain excites the NE energy pathway → stimulates α1 receptors → activates D2 receptors in the limbic system → induces psychosis

Use venlafaxine with caution/not in patients with schizophrenia

Milnacipran increases NE energy → stimulates α1 receptors on cerebral blood vessels → constricts cerebral blood vessels → cerebral ischemia and hypoxia → dizziness, headache, and drowsiness

Methylphenidate increases NE energy → stimulates vascular α1 receptors → constricts vestibular blood vessels → dizziness; drivers or those operating dangerous machines should use it with caution

Constrict cochlear blood vessels → tinnitus, hearing loss

Milnacipran increases NE energy → stimulates striatal beta receptors → inhibits striatal DA energy → tremors, akathisia, bruxism, etc.

Propranolol blocks beta receptors and treats tremor, akathisia, bruxism, etc.

Bupropion increases NE energy → stimulates α1 receptors in temporal lobe cortex → hypervigilance → induces epilepsy

increase heart rate

Reduce heart rhythm variability

Myocardial ischemia

Venlafaxine increases NE energy→stimulates α1 receptors→constricts blood vessels→increases blood pressure

Use with caution: patients with coronary heart disease or cerebral hemorrhage. Contraindications: Patients with uncontrolled hypertension

Venlafaxine increases NE energy → stimulates α2 receptors in the medullary cardiovascular center → reduces NE release → orthostatic hypotension → syncope

Antipsychotics block α1 receptors → relax peripheral venous vascular smooth muscle → cause orthostatic hypotension

Duloxetine increases NE energy → enhances mesolimbic DA pathway activity → promotes DA release in the phrenic nucleus accumbens → stimulates D1 receptors → enhances sexual desire (increases the frequency of masturbation)

Impotence

vaginal dryness

Milnacipran increases NE energy→stimulates α1 receptors→increases the smooth muscle peristalsis ability of the vas deferens, seminal vesicles, and seminal ducts→increases the contraction of prostate smooth muscle→promotes sperm leakage into the urethral bulb→causing premature ejaculation and semen discharge during urination.

Chlorpromazine blocks α1 receptors → inhibits peristalsis and contraction → inhibits the leakage of semen into the bulb of the urethra → delays ejaculation

Milnacipran increases NE energy → stimulates testicular α1 receptors → contracts testicular blood vessels → testicular ischemia and pain

Atomoxetine increases NE energy→stimulates α1 receptors→constricts blood vessels→insufficient blood supply to the uterus and fetus→abortion and reduced Apgar scores in neonatal health assessment

Atomoxetine increases NE energy → inhibits salivary gland secretion/inhibits gastrointestinal motility → dry mouth/anorexia and weight loss

Milnacipran increases NE energy → stimulates Oddis sphincter α1 receptors → contracts Oddis sphincter → poor bile flow → indigestion/obstructive jaundice, right upper quadrant tenderness/liver damage/dark urine

Methylphenidate increases NE energy → contracts the sphincter of Oddis → bile flows into the pancreas → pancreatic enzyme is activated into pancreatic enzyme → pancreatitis → fever, shock/blood amylase higher than 500U/pancreatic juice stimulates the peritoneum

Milnacipran increases NE energy → stimulates α1 receptors → inhibits intestinal motility → constipation

Venlafaxine increases NE energy → stimulates adipocyte β3 receptors → promotes lipolysis → sweating and hot flashes

Duloxetine increases NE energy → stimulates α1 receptors in the internal bladder sphincter → contracts the bladder sphincter →

Clozapine inhibits α1 receptors → relaxes the internal bladder sphincter → nocturnal enuresis and daytime urinary incontinence

Duloxetine increases NE energy → stimulates the locus coeruleus-supraoptic nucleus NE pathway → promotes ADH release → increases the permeability of the distal convoluted tubule and collecting duct to water → increases water reabsorption but no change in sodium reabsorption → hyponatremia Symptoms, hypernatremia→Cell edema→

Milnacipran increases NE energy → stimulates the α1 receptor of the pupillary muscle → contracts the pupillary muscle → dilates the pupil and narrows the anterior chamber angle → increases intraocular pressure

Use with caution: People with glaucoma or increased intraocular pressure. Contraindications: Untreated angle-closure glaucoma.

Milnacipran increases NE energy→stimulates α1 receptors→contracts arrector pili muscles→piloerection

Bupropion increases NE energy → inhibits incoming pain signals from the dorsal horn of the spinal cord → numbness

hair loss

itching

Raynaud's phenomenon

Vitiligo

Bupropion increases NE energy → activates lymphocytes → produces stress immunosuppressive proteins → increases infection and influenza rates

Antidepressants that block α2 receptors: mirtazapine, trazodone

Atypical antipsychotics block α2A receptors from strong to weak: risperidone (moderate) = aripiprazole = lurasidone > clozapine (weak) > olanzapine > quetiapine

Memory reorganization, abnormal excitement → hallucination

Abnormal excitement of primitive thinking (intuition) → primary delusion

Explaining abnormal experiences → secondary delusions

Recall ability decreases but familiarity remains → false memory → delusion

Tricyclic antidepressants, sertraline, bupropion, and methylphenidate block DA recycling and can worsen delusions and hallucinations when used alone in schizophrenia.

Improve delusions and hallucinations

For positive symptoms, except for clozapine and olanzapine, the other atypical antipsychotics are equivalent to typical antipsychotics

During prolonged treatment with antipsychotics, D2 receptors are upregulated by an average of 34%. Sudden discontinuation or reduction of the drug → rebound enhancement of D2 receptor function → rapid onset of DA hypersensitivity psychosis.

The knowledge structure and motivation orientation have not changed.

D1 receptor agonist

dopamine↑

NMDA receptor activity↑

Brain-derived neurotrophic factor↑

Activity of GABA interneurons containing somatostatin action site↑

Levodopa → activates striatal D2 receptors → inhibits muscle tone → improves Parkinson’s syndrome

Antipsychotics → block striatal D2 receptors →

Long-term use of antipsychotics → increased D2 receptor sensitivity (adaptive hypersensitivity) → hypotonia → tardive dyskinesia

Dopamine D2 receptor partial agonists (bromocriptine, aripiprazole) → stimulate prolactin cell D2 receptors → inhibit prolactin secretion

Antipsychotics → block D2 receptors on prolactin cells → disinhibitory release of prolactin

Hyperprolactinemia: women＞25ug/L, men＞20ug/L

Hyperprolactinemia → negative feedback inhibition → luteinizing hormone ↓ → progesterone ↓, follicle-stimulating hormone ↓ → estrogen ↓, testosterone ↓

DA antagonists (olanzapine, risperidone, quetiapine) → intermittent limb movements during sleep → discontinuous sleep at night and sleepiness during the day

Levodopa metabolic pathway ① is converted into DA, ② is converted into melanin → pigmentation

Levodopa → stimulates D2 receptors → inhibits intestinal motility → constipation

Sulpiride and metoclopramide → block D2 receptors → promote intestinal motility

Loneliness, Parkinson's disease, DA blockers

Monoamine oxidase inhibitors →Hindered degradation of monoamines (5-HT, NE, DA) → Increased concentrations of 5-HT, NE and DA → Increased DA energy

An exciting sense of desire for a reward that is about to be received, for example: the pleasure of flirting between men and women

Produce a calming sense of happiness in response to a reward that has been received, for example: acute drinking → stimulate the release of β-endorphin → pleasure

Stimulate μ receptor → increase DA energy

Promote DA release→increase DA energy

Block DA recycling→increase DA energy

Antagonize NMDA receptors → disinhibitory release of DA → increase DA energy

Stimulate nicotine receptors → promote DA release → increase DA energy