What other than 5ht2a in serotonin system is implicated in psychosis?

Medications
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I have a question. Mirtazapine is used for treatment of depression. It increases noradrenaline and serotonin while blocking the 5ht2a receptor, and does several other things as well. On my country’s own official medicine website it says that 1 out of 100 people experience psychosis-related side-effects like hallucinations.
So my question is, is it possible that some other serotonin receptor than the 5ht2a receptor can cause psychotic symptoms like the positive ones? Maybe someone is more familiar with the literature on psychosis.

The reason for asking is that I am sensitive to serotonin-increasing chemicals, I tend to have various harsh side-effects and I want to start taking mirtazapine because it blocks the 5ht2a receptor and it’s the only drug on the market in my country which has this property while affecting the fewest other receptors. I am not taking any antipsychotic and want to avoid having to do so.

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I don’t ask too many questions lately, I just take the meds that my psychiatrist prescribes me.
Playing doctor got me into trouble in the past.

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I was not prescribed anything, the psychiatric ward I am linked to does not medicate its patients (unless needed) so I don’t have to. I myself want to block the 5ht2a receptor to remove my irritability, fatigue, moodiness and such.

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For the last time mirtazapine is just an anti depressant used for depression and moods.

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@NoEmotions If you don’t mind my asking, what was your diagnosis?

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Schizotypal pd. Started as prodromal schizophrenia.

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You mentioned you’re not on meds. Are you seeing a pdoc or therapist currently?

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I am linked to a psychiatric ward as it’s the way it works in my country, don’t want to answer too many questions. What’s the reason for asking?

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I just wanted to make sure you had a pdoc you could discuss the mirtazapine with.

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You would be humored to know that the psychiatric ward I am with is not too keen on medicating people. I guess it’s a part of the anti-“big pharma” movement and the fact of living in a highly liberalized country. Of course, if I behave badly I’m sure that would change :joy:

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Uhh not sure why they liked your comment but never mind.
I feel the thread went off-topic, does anyone know why my country’s official medication website says in side-effects section that 1 out of 100 experience the mentioned side-effects. Could it be from the adrenergic side of the drug?

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You should really be discussing medication options with a pdoc rather than relying on Google searches and internet forums.

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Maybe I didn’t say this already but I have talked to a psychiatrist.
The options are, as I’ve mentioned, this drug or others I can’t benefit from. There are various atypical antipsychotics that I could ask for but they have a much larger and unnecessary pharmacology (I don’t benefit from dopamine antagonism, for example). Mirtazapine is prescribed off-label in some case for treatment of insomnia and I believe anxiety disorders, as well as add-on treatment for specific psychotic disorders (I think, not sure).

I know that there are users here who are much more familiar with the literature than I am (as the previous mod also insisted on, that I didn’t understand what I was saying), so was hoping that perhaps they could help me out.

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Good to hear that. Did your pdoc advise you to try the Mirtazapine then?

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No… I was advised to not bother since my diagnosis and prognosis does not necessitate it, unless I was really sure I wanted.

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I found this very interesting resource which tries to figure out at what dosages, mechanism, etc., mirtazapine becomes a hallucinogen.


I have never until now heard that the opioid system can cause those effects the page implies, so this is a surprise.

bla bla bla don’t abuse drugs and take your medications bla bla bla

Am I allowed to make this comment? It’s very hard to see, I don’t even know what I did “wrong” last time. If not, you can remove it and I’ll know. I suppose there is no reason to comment on this topic anymore.

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@NoEmotions

You have schizotypal personality disorder, so maybe you’re preoccupied with Mirtazapine?

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is that a part of the disease?

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@NoEmotions

Yes.

discomfort in social situations
no close friends
inappropriate display of feelings
odd behavior or appearance
odd beliefs, fantasies, or preoccupations
odd speech

You may want to ask your pdoc about Clozaril, but you also need Cognitive-Behavioral Therapy

It’s not your fault, you have a disorder.

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I know about all those things (I don’t have magical thinking/ideation, btw) but never heard about preoccupation (obsessiveness?) being a part of it. I guess it explains why I obsessively hate some people and just can’t let go of it? Sort of like in autism spectrum disorder or OCD on wheels :laughing:

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