Mechanism of action
- See also: Serotonin 5-HT2A receptor agonist, Serotonin §Psychedelics, and Entactogen §Mechanism of action
Most serotonergic psychedelics act as non-selective agonists of serotonin receptors, including of the serotonin 5-HT2 receptors, but often also of other serotonin receptors, such as the serotonin 5-HT1 receptors. They are thought to mediate their hallucinogenic effects specifically by activation of serotonin 5-HT2A receptors. Psychedelics (including tryptamines like psilocin, DMT, and 5-MeO-DMT; phenethylamines like mescaline, DOM, and 2C-B; and ergolines and lysergamides like LSD) all act as agonists of the serotonin 5-HT2A receptors. Some psychedelics, such as phenethylamines like DOM and 2C-B, show high selectivity for the serotonin 5-HT2 receptors over other serotonin receptors. There is a very strong correlation between 5-HT2A receptor affinity and human hallucinogenic potency. In addition, the intensity of hallucinogenic effects in humans is directly correlated with the level of serotonin 5-HT2A receptor occupancy as measured with positron emission tomography (PET) imaging. Serotonin 5-HT2A receptor blockade with drugs like the semi-selective ketanserin and the non-selective risperidone can abolish the hallucinogenic effects of psychedelics in humans. However, studies with more selective serotonin 5-HT2A receptor antagonists, like pimavanserin, are still needed.
In animals, potency for stimulus generalization to the psychedelic DOM in drug discrimination tests is strongly correlated with serotonin 5-HT2A receptor affinity. Non-selective serotonin 5-HT2A receptor antagonists, like ketanserin and pirenperone, and selective serotonin 5-HT2A receptor antagonists, like volinanserin (MDL-100907), abolish the stimulus generalization of psychedelics in drug discrimination tests. Conversely, serotonin 5-HT2B and 5-HT2C receptor antagonists are ineffective. The potencies of serotonin 5-HT2 receptor antagonists in blocking psychedelic substitution are strongly correlated with their serotonin 5-HT2A receptor affinities. Highly selective serotonin 5-HT2A receptor agonists have recently been developed and show stimulus generalization to psychedelics, whereas selective serotonin 5-HT2C receptor agonists do not do so. The head-twitch response (HTR) is induced by serotonergic psychedelics and is a behavioral proxy of psychedelic-like effects in animals. The HTR is invariably induced by serotonergic psychedelics, is blocked by selective serotonin 5-HT2A receptor antagonists, and is abolished in serotonin 5-HT2A receptor knockout mice. In addition, there is a strong correlation between hallucinogenic potency in humans and potency in the HTR assay. Moreover, the HTR paradigm is one of the only animal tests that can distinguish between hallucinogenic serotonin 5-HT2A receptor agonists and non-hallucinogenic serotonin 5-HT2A receptor agonists, such as lisuride. In accordance with the preceding animal and human findings, it has been said that the evidence that the serotonin 5-HT2A receptor mediates the hallucinogenic effects of serotonergic psychedelics is overwhelming.
The serotonin 5-HT2A receptor activates several downstream signaling pathways. These include the Gq, β-arrestin2, and other pathways. Activation of both the Gq and β-arrestin2 pathways have been implicated in mediating the hallucinogenic effects of serotonergic psychedelics. However, subsequently, activation of the Gq pathway and not β-arrestin2 has been implicated. Interestingly, Gq signaling appeared to mediate hallucinogenic-like effects, whereas β-arrestin2 mediated receptor downregulation and tachyphylaxis. The lack of psychedelic effects with non-hallucinogenic serotonin 5-HT2A receptor agonists may be due to partial agonism of the serotonin 5-HT2A receptor with efficacy insufficient to produce psychedelic effects or may be due to biased agonism of the serotonin 5-HT2A receptor. There appears to be a threshold level of Gq activation (in terms of intrinsic activity, with EmaxTooltip maximal efficacy >70%) required for production of hallucinogenic effects. Full agonists and partial agonists above this threshold are psychedelic 5-HT2A receptor agonists, whereas partial agonists below this threshold, such as lisuride, 2-bromo-LSD, 6-fluoro-DET, 6-MeO-DMT, and Ariadne, are non-hallucinogenic 5-HT2A receptor agonists. In addition, biased agonists that activate β-arrestin2 signaling but not Gq signaling, such as ITI-1549, IHCH-7086, and 25N-N1-Nap, are non-hallucinogenic serotonin 5-HT2A receptor agonists.
The hallucinogenic effects of serotonergic psychedelics may be critically mediated by serotonin 5-HT2A receptor activation in the medial prefrontal cortex (mPFC). Layer V pyramidal neurons in this area are especially discussed. Activation of serotonin 5-HT2A receptors in the mPFC results in marked excitatory and inhibitory effects as well as increased release of glutamate and GABA. Direct injection of serotonin 5-HT2A receptor agonists into the mPFC produces the HTR. Drugs that suppress glutamatergic activity in the mPFC, including AMPA receptor antagonists, metabotropic glutamate mGlu2/3 receptor agonists, μ-opioid receptor agonists, and adenosine A1 receptor agonists, block or suppress many of the neurochemical and behavioral effects of serotonergic psychedelics, including the HTR. Metabotropic glutamate mGlu2 receptors are primarily expressed as presynaptic autoreceptors and have inhibitory effects on glutamate release. Serotonergic psychedelics have been found to produce frontal cortex hyperactivity in humans in PET and single-photon emission computed tomography (SPECT) imaging studies. The PFC projects to many other cortical and subcortical brain areas, such as the locus coeruleus, nucleus accumbens, and amygdala, among others, and activation of the PFC by serotonergic psychedelics may thereby indirectly modulate these areas. In addition to the PFC, there is moderate to high expression of serotonin 5-HT2A receptors in the primary visual cortex (V1), as well as expression of the serotonin 5-HT2A receptor in other visual areas, and activation of these receptors may contribute to or mediate the visual effects of serotonergic psychedelics. Serotonergic psychedelics also directly or indirectly modulate a variety of other brain areas, like the claustrum, and this may be involved in their effects as well. Psychedelics may work in part by disrupting the default mode network (DMN), a collection of interconnected brain areas which has high serotonin 5-HT2A receptor expression and is said to construct our sense of space, time, and self. The ego dissolution and altered time perception caused by psychedelics correlates with DMN desynchronization, whereas psychedelic visual imagery correlates with disruption in the visual cortex.
Serotonin, as well as drugs that increase serotonin levels, like the serotonin precursor 5-hydroxytryptophan (5-HTP), serotonin reuptake inhibitors, and serotonin releasing agents, are non-hallucinogenic in humans despite increasing activation of serotonin 5-HT2A receptors. Serotonin is a hydrophilic molecule which cannot easily cross biological membranes without active transport, and the serotonin 5-HT2A receptor is usually expressed as a cell surface receptor that is readily accessible to extracellular serotonin. The HTR, a behavioral proxy of psychedelic-like effects, appears to be mediated by activation of intracellularly expressed serotonin 5-HT2A receptors in a population of mPFC neurons that do not also express the serotonin transporter (SERT) and hence cannot be activated by serotonin. In contrast to serotonin, serotonergic psychedelics are more lipophilic than serotonin and are able to readily enter these neurons and activate the serotonin 5-HT2A receptors within them. Artificial expression of the SERT in this population of neurons in animals resulted in a serotonin releasing agent that doesn't normally produce the HTR being able to do so. Although serotonin itself is non-hallucinogenic, at very high concentrations achieved pharmacologically (e.g., injected into the brain or with massive doses of 5-HTP) it can produce psychedelic-like effects in animals by being metabolized by indolethylamine N-methyltransferase (INMT) into more lipophilic N-methylated tryptamines like N-methylserotonin and bufotenin (N,N-dimethylserotonin).
In addition to their hallucinogenic effects, serotonergic psychedelics may also produce a variety of other effects, including psychoplastogenic (i.e., neuroplasticity-enhancing), antidepressant, anxiolytic, empathy-enhancing or prosocial effects, anti-obsessional, anti-addictive, anti-inflammatory and immunomodulatory effects, analgesic effects, and/or antimigraine effects. While psychedelics themselves are also being clinically evaluated for these potential therapeutic benefits, non-hallucinogenic serotonin 5-HT2A receptor agonists, which are often analogues of serotonergic psychedelics, have been developed and are being studied for potential use in medicine in an attempt to provide some such benefits without hallucinogenic effects.
Although the hallucinogenic effects of serotonergic psychedelics are thought to be mediated by serotonin 5-HT2A receptor activation, interactions with other receptors, such as the serotonin 5-HT1A, 5-HT1B, 5-HT2B, and 5-HT2C receptors among many others, may additionally contribute to and modulate their effects. Many psychedelics show pronounced biased agonism at the serotonin 5-HT2C receptor. Certain psychedelics, including LSD and psilocin, have been reported to act as highly potent positive allosteric modulators of the tropomyosin receptor kinase B (TrkB), one of the signaling receptors of brain-derived neurotrophic factor (BDNF). However, subsequent studies failed to reproduce these findings and instead found no interaction of LSD or psilocin with TrkB. Moreover, the psychoplastogenic effects of serotonergic psychedelics, including dendritogenesis, spinogenesis, and synaptogenesis, appear to be mediated by activation of serotonin 5-HT2A receptors, whereas psychedelics do not generally stimulate neurogenesis.
The factors responsible for differences in psychoactive and hallucinogenic effects between different psychedelics are incompletely understood but may include (1) differences in selectivity for the serotonin 5-HT2A receptor or off-target activity; (2) differences in functional selectivity for different serotonin 5-HT2A receptor downstream signaling pathways; and (3) differences in patterns or balances of distribution to different brain areas.
Various approaches are available for estimating equivalent doses of psychedelics between animals and humans. Examples include allometric scaling formulas and receptor occupancy studies.
Neurotoxicity
- See also: Psychedelic microdosing §Neurological toxicity
A variety of serotonergic psychedelics have been assessed and found to produce neurotoxicity at high concentrations in vitro and/or high doses in vivo in rodents. These psychedelics have included DOI, 2C-B, 25B-NBOMe, 25C-NBOMe, 5-MeO-DiPT, 5-MeO-MiPT, methallylescaline (MAL), and BOD, among others. The neurotoxicity induced by the preceding psychedelics has included MDMA-like serotonergic neurotoxicity, for instance with DOI, MAL, and 5-MeO-DiPT. The neurotoxicity of psychedelics has been found to be partially blocked by serotonin 5-HT2A receptor inhibition, which was also the case with the neurotoxicity of MDMA. Besides producing neurotoxicity on their own, psychedelics have been found to potentiate the serotonergic neurotoxicity of MDMA via serotonin 5-HT2 receptor activation in rodents.
DOM is known to metabolize into 2,5-DDM-DOM (2-O-,5-O-didesmethyl-DOM; 2,5-dihydroxy-4-methylamphetamine), which bears a close resemblance to 6-hydroxydopamine (6-OHDA; 2,4,5-trihydroxyphenethylamine) and has been found to be a potent neurotoxin similarly. Other related phenethylamine psychedelics may also undergo similar metabolism and form analogous potentially neurotoxic metabolites.
Chronic administration of LSD has been associated with long-lasting schizophrenia-like behavioral changes in rodents, which was not blocked by serotonin 5-HT2A receptor antagonism but may instead be related to LSD's dopamine D2-like receptor agonism. Single macrodoses of LSD do not produce such changes in rodents, but the preceding findings may have implications for continuous psychedelic microdosing with LSD.
