Putative atypical antipsychotics with mixed dopaminergic (D1, D2) and serotonergic (5HT2) activity: The design evolution of ZD3638

Schizophrenia - advances in drug therapy

It has become increasingly clear that classical drug treatments for schizophrenia, while valuable for many patients, are far from optimal. Not only do they induce unpleasant side-effects, but they are also limited in their antipsychotic efficacy in a substantial proportion of patients. Using the uniquely effective but pharmacologically complex drug, clozapine, as a model, a variety of receptors in addition to the dopamine D2 site have been identified as targets for drug development; the 5-HT2A site has received the greatest interest in this respect. Several new drugs in development as antipsychotics have pharmacological effects at 5-HT2 and other clozapine-sensitive receptors; the receptor mechanisms underlying both the antipsychotic efficacy and limitations of these compounds are reviewed here, as are some other potential drug therapies that do not share clozapine's receptor pharmacology.