The Future of Antipsychotic Medication – Conversations with Dr Stephen Stahl

Posted on May 29, 2017

This interview is the final one as part of a series of brief interviews where Dr Sanil Rege talks to Dr Stephen Stahl about key issues that face psychiatry and our patients.  Dr Stahl, MD, is a practicing Psychiatrist in Carlsbad, USA, and author of the best-selling textbook, Essential Psychopharmacology. Dr Stahl has held faculty positions at Stanford University, the University of California at Los Angeles, the Institute of Psychiatry London, the Institute of Neurology London, and, currently, at the University of California at San Diego.

Take home messages –

  • The Dopamine – Serotonin route has just about been exhausted.
  • Newer mechanisms –

1.Pure 5HT2A receptor antagonism e.g. Pimavanserin in psychosis of Parkinson’s disease

2.Glutamate – based therapies raised hope but were not successful in longer term trials, this remains back to the drawing board.

3.Cognitive enhancers – Boosting acetylcholine at nicotinic receptors e.g. Encenicline – α7 nicotinic receptor partial agonist

  • NMDA hypofunction hypothesis of Schizophrenia

Glutamate neurons plug into the GABA neurons and in schizophrenia the connection between them is thought to be neurodevelopmentally faulty. When you’re born you have a genetic load that biases your brain not to wire correctly and when it reorganises in childhood and adolescence it uncovers this deficiency which has downstream effects on dopamine but upstream effects on cognition and negative symptoms.

Want to Learn More? Watch the entire series with Dr Stahl here.