Which type of medication is primarily used to address negative symptoms of schizophrenia?

The treatment of negative symptoms of schizophrenia is often challenging, as these symptoms—such as lack of motivation, social withdrawal, and reduced emotional expression—are less responsive to traditional antipsychotic medications, which primarily target positive symptoms. The answer focuses on the role of serotonin in the pathophysiology of schizophrenia.

5-HT(2A) antagonists, which belong to a class of drugs called atypical antipsychotics, play a significant role in managing negative symptoms. These medications not only block serotonin receptors but also have a more favorable profile for addressing symptoms like apathy and anhedonia. By modulating serotonergic transmission, they help improve mood and social functioning, which are crucial for patients experiencing negative symptoms.

In contrast, D2 receptor antagonists primarily address positive symptoms of schizophrenia (such as hallucinations and delusions) by blocking dopamine receptors. This mechanism does not directly target negative symptoms. SSRIs and tricyclic antidepressants are primarily used for mood disorders and may affect depressive symptoms within schizophrenia but are not first-line treatments for schizophrenia itself. Their efficacy in managing negative symptoms is limited compared to the atypical antipsychotics that antagonize 5-HT(2A) receptors.

Thus, 5-