Die kleinste Tablette ist schon zu viel !

20 mg of citalopram blocks 80% of serotonin transporters. 40 mg—the double dose—achieves 86%. And the smallest tablet available already blocks 72%. Almost all psychotropic drugs are dosed in such a way that the smallest available strength already nearly saturates the target receptor. We have room for improvement at the upper end, which no one needs. At the lower end, it's lacking precisely where we desperately need it: during dose titration, in geriatric psychiatry, and especially during discontinuation. In this video, I'll review the PET studies on receptor occupancy, explain why this is the case, and at the end, I'll state which strengths I would produce. 📖 Read the full article with all the graphics here: https://psychcastmitjan.de/kleinste-t... ▬▬▬ CHAPTERS ▬▬▬ 00:00 Introduction 01:45 Citalopram: at 10 mg, the effect is almost complete 02:39 Venlafaxine: 37.5 mg is not a low dose 04:05 Mirtazapine: histamine is fully occupied, serotonin unaffected 05:03 Antipsychotics: the therapeutic window 06:06 Aripiprazole: the 5 mg tablet is a high dose 07:21 Risperidone: this is what good granulation looks like 08:31 Why we need smaller strengths 14:25 My suggestions ▬▬▬ STUDIES ▬▬▬ Serotonin transporters, dose-occupancy curves Meyer JH et al., Am J Psychiatry 2004;161:826–835 https://doi.org/10.1176/appi.ajp.161.... Systematic review: Dose vs. SERT occupancy Sørensen A et al., Mol Psychiatry 2022;27:192–201 https://doi.org/10.1038/s41380-021-01... Venlafaxine on the noradrenaline transporter Arakawa R et al., Int J Neuropsychopharmacol 2019;22:278–285 https://doi.org/10.1093/ijnp/pyz003 Mirtazapine, histamine H1 binding Sato H et al., Psychopharmacology 2013;230:227–234 https://doi.org/10.1007/s00213-013-31... Mirtazapine does not enhance serotonergic transmission Millan MJ et al., Eur J Neurosci 2000;12:1079–1095 https://doi.org/10.1046/j.1460-9568.2... D2 binding: 65% efficacy, 72% prolactin, 78% EPS Kapur S et al., Am J Psychiatry 2000;157:514–520 https://doi.org/10.1176/appi.ajp.157.... Aripiprazole: 2 mg results in 71.6% D2 occupancy Kegeles LS et al., Neuropsychopharmacology 2008;33:3111–3125 https://doi.org/10.1038/npp.2008.33 Hyperbolic tapering Horowitz MA, Taylor D, Lancet Psychiatry 2019;6:538–546 https://doi.org/10.1016/S2215-0366(19... ▬▬▬ MORE FROM ME ▬▬▬ Newsletter, free: https://psychcast.short.gy/news Video courses: https://myablefy.com/s/psychcast All content searchable: https://psychcast-katalog.netlify.app/ Instagram:   / psychcastmitjan   TikTok:   / psychcastmitjan   Books (affiliate links): Psychopharmacotherapy at your fingertips: https://amzn.to/4cDGrqy Managing Psychotropic Drugs: https://amzn.to/47DVhwE ▬▬▬ I am Dr. Jan Dreher, a specialist in psychiatry and psychotherapy and Medical Director of the Königshof Clinic in Krefeld. This video does not replace individual medical advice. Do not change the dose of your medication on your own, but speak with your doctor beforehand. #PsychotropicDrugs #Psychiatry #Antidepressants