“hyperthermia in neuroleptic malignant syndrome is due to the dominant effect of serotonin in the thermoregulatory center either by blocking the dopamine receptor or by enhancing the serotonin secretion.” [34]. It is accepted that increasing serotonin neurotransmitter concentration in the brain favors the development of hyperthermia (Serotonin Syndrome; SS)
https://pmc.ncbi.nlm.nih.gov/articles/PMC8952796/
In conclusion, stimulation of 5-HT1A receptors causes central sympatho-inhibition and an increase in cardiac vagal drive [35].
Activation of 5-HT2A and 5-HT2B receptors has predominantly excitatory effects. Some authors understand SS as a consequence of excessive activation of 5-HT2A receptors [49]. The available evidence supports the view that activation of these receptors is associated with hyperthermia,
Why DMT works all the time and LSD won't - Tobias Buchborn
Based on the theoretical model presented the “ideal” antidote against serotonin syndrome hyperthermia appears to be an antagonist at the 5-HT receptor subtypes 2, 4 and 6 and an agonist at the receptor subtypes 1, 3 and 7. Very broadly speaking, such a profile translates in a sympatholytic effect.
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