For the psychiatry board and in-service examination, it is important to have a strong understanding of neurotransmitters, as this understanding will translate into a more comprehensive knowledge of the mechanism of many medications and diseases. 

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Receptor Basics

Ionotropic Receptors

  • Also known as ligand-gated ion channels
    • These receptors are directly linked with ion channels and open or close these channels in response to the binding of neurotransmitters (ligands).
  • Ionotropic receptors are typically composed of four or five protein subunits that come together to form a pore through the neuronal membrane. The specific arrangement and types of subunits can affect the receptor’s properties and responses.
  • They are known for providing an immediate response by directly controlling the ion flow into and out of neurons, directly converting chemical signals into electrical ones.
  • Medications targeting ionotropic receptors often have immediate effects, such as rapid relief from acute anxiety, seizure cessation, or immediate neurotransmission modification.
  • The fast-acting nature of these drugs often leads to rapid tolerance, dependence, and potential withdrawal, necessitating careful management.

Mechanism of Action

  • When a neurotransmitter molecule binds to its specific site on the receptor, it induces a conformational change in the receptor’s structure.
  • This conformational change causes the pore to open, allowing specific ions (such as Na+, K+, Ca2+, or Cl-) to flow across the neuron’s membrane.
  • The ion flow creates an immediate electrical effect, called a postsynaptic potential, which can be excitatory or inhibitory, altering the neuron’s excitability in response to stimuli.


  • GABA-A receptors: These are ionotropic receptors targeted by benzodiazepines and certain general anesthetics, increasing chloride ion flow into neurons to enhance inhibitory effects, thereby reducing anxiety and promoting sedation.
  • NMDA and AMPA receptors (glutamate receptors): These receptors play crucial roles in synaptic plasticity, learning, and memory. Dysfunction in these glutamatergic systems is implicated in various psychiatric conditions like schizophrenia (NMDA receptor hypo-function) and mood disorders.


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