YT YouTube2Text

YouTube2Text → Transcripts → Quali nuovi psicofarmaci dobbiamo aspettarci nel futuro

Quali nuovi psicofarmaci dobbiamo aspettarci nel futuro — Transcript

by Dott. Valerio Rosso · 1,971 words · 340 segments · language en · Watch on YouTube

Open in transcriber Summarize with AI Download SRT/VTT

Full transcript

0:00So, if you ask someone on the street
0:02how an antidepressant works, what’s
0:04the first word that’s going to come
0:06out? Serotonin. Nine times out of 10,
0:10they’ll answer with serotonin—it
0:12increases serotonin, it rebalances it,
0:14or if they’re really well-informed,
0:16they'll mention reuptake inhibition,
0:18all that stuff. At most, someone might
0:22add the word dopamine, and, well, if
0:24someone is really, really prepared,
0:26you’ll hear the word norepinephrine.
0:30Well, for decades, psychopharmacology
0:32has revolved almost entirely around
0:35these three names: serotonin, dopamine,
0:37agonists, antagonists, and, obviously,
0:40norepinephrine. And it’s precisely
0:44for this reason, for this reductionism
0:46we’ve heard for so many years, that
0:48today I want to talk about the drugs
0:51that will likely arrive, because the
0:53most interesting novelty is that we are
0:55finally stepping out of that enclosure
0:58based on these three words: serotonin,
1:00dopamine, norepinephrine. We are, at
1:03the very least, trying to step out of
1:05that enclosure. Let’s start with
1:07something that almost nobody mentions,
1:09which is arguably the most important
1:11thing to know. Serotonin, dopamine, and
1:14norepinephrine are very important
1:15neurotransmitters, but the neurons that
1:17produce them are relatively few, right?
1:20They are gathered in small nuclei in
1:23the brainstem and midbrain, which then
1:25project throughout the entire brain,
1:28certainly, but they are not the most
1:30abundant neurotransmitters; they are
1:33modulators, let’s say, like volume
1:35knobs on my instruments. The real
1:40traffic, the majority of
1:41neurotransmitters—the foundation—
1:43passes through somewhere else entirely;
1:46for example, it passes through
1:48glutamate, which is the main excitatory
1:50neurotransmitter of the central nervous
1:52system. The vast majority of neurons in
1:56the cortex communicate using glutamate
1:59and its, let's call it, inhibitory
2:01counterbalance: GABA. Yeah, GABA. If
2:05the brain were a city, glutamate and
2:07GABA would run the show. Glutamate
2:10would be the accelerator and GABA would
2:12be the brake for almost every car on
2:15the road. I mean, let’s use an
2:17example—I don’t know what kind of
2:18example I’m giving you, but one
2:19pushes, and the other brakes. Yet, for
2:21decades, it’s been talked about very
2:23little, both inside and outside of
2:25conferences. In reality, there are so
2:27many people out there who don't have a
2:28clear idea about GABA and glutamate.
2:31Then there is more, though; there is
2:33also acetylcholine. Acetylcholine,
2:36which, mind you, is not the most
2:38abundant in the brain—it’s
2:40certainly not like glutamate or GABA—
2:41but it was the first neurotransmitter
2:43ever discovered, and it’s the one
2:45that, you know, makes muscles contract,
2:47right? It regulates a good portion of
2:51the autonomic nervous system, and in
2:53the brain, it plays a key role in
2:54attention, memory, and, in turn, the
2:56regulation of dopaminergic activity.
2:59Well, an old lady, one might say, of
3:02neurochemistry, but a lady who is
3:03coming back into fashion: acetylcholine
3:06. And here we come to the question
3:08after this introduction. An important
3:09question. Are there psychotropic drugs
3:12that work on these systems—obviously
3:15I cannot say new because they are not
3:17—on these systems that have been
3:19largely overlooked by
3:21psychopharmacology until now? Yes, yes,
3:24absolutely yes. Some are already here,
3:26and many others will arrive. A small
3:28aside: if you are interested in
3:30psychopharmacology, please follow my
3:32project, www.psfarmacologia.it. And on
3:37Instagram, follow the corresponding
3:40page, psicofarmacologia.it. Search for
3:43"psicofarmacologia" on Instagram, you
3:44will find everything. Likewise, if you
3:47search for "psicofarmacologia" on
3:49Google, you will see that the first
3:50result is psicofarmacologia.it, which
3:52is my project. A site that aspires to
3:55be a reference for medical students,
3:58residents, and perhaps even some, uh,
4:00doctors who are not, how should I put
4:03it, fully specialized in psychiatry or
4:06neurology; but I guarantee you it is
4:08very well done. It contains all the
4:12theory and practice a healthcare
4:14professional needs to truly understand
4:16how psychotropic drugs work, because
4:19understanding how they work is the
4:21prerequisite. To use them well. Uh,
4:25that is my motto, the motto of
4:26psicofarmacologia.it. But let's move on
4:29. So, are there psychotropic drugs that
4:32work on these new systems—very old
4:33systems, actually, but addressed well
4:35by psychopharmacology? Yes, absolutely
4:38yes. On the glutamatergic side, the
4:42turning point in recent years—so,
4:44already stuff on the market—has been
4:46ketamine and, shortly after, uh, let's
4:48better say esketamine nasal spray. Uh,
4:52ketamine is almost free, esketamine
4:54costs a lot; well, anyway, it has
4:56specific approval for
4:57treatment-resistant depression. But we
4:59should, as it were, in my opinion, also
5:01look a bit at intravenous ketamine
5:03which, moreover, also has better
5:05results. But if you want to be
5:07practical and fast, esketamine nasal
5:09spray has been directly approved for
5:10treatment-resistant depression. So, a
5:13drug that acts on the glutamate
5:15receptor and that, in a portion of
5:17patients, reduces depressive symptoms
5:20in hours, hours or days at most instead
5:22of weeks. To this has been added a
5:26combination of dextromethorphan and
5:27bupropion with a glutamatergic action,
5:29a new drug that will arrive, and on the
5:31GABA side, there is this combination of
5:33drugs, for example in this case
5:35dextromethorphan, the one, to be clear,
5:37from cough syrup, with bupropion—just
5:39think about it. So they, too, have a
5:42glutamatergic action. Instead, on the
5:45GABA side, neurosteroids have arrived
5:47for postpartum depression, uh,
5:49therefore allopregnanolone. Incredible,
5:52it works very well for postpartum
5:54depression. They are not magic wands,
5:56okay? They have limitations, costs,
5:59side effects, and work on only a
6:01portion of people, obviously, but they
6:03have, let's say, broken the dogma of
6:05the three molecules that seemed to have
6:07to work for everything—serotonin,
6:09dopamine, and norepinephrine. On the
6:12cholinergic side, however, the biggest
6:14news concerns schizophrenia. In 2024,
6:17the first antipsychotic that does not
6:19directly block dopamine receptors was
6:21approved in the United States, okay?
6:24Instead, it acts on the M1 and M4
6:26muscarinic acetylcholine receptors and
6:28modulates dopamine in an, let's say,
6:29indirect way. After more than 70 years
6:33of antipsychotics all built in some way
6:35on the same principle, that is, as
6:38dopamine antagonists, this is an
6:40important paradigm shift—a major, I
6:42would say radical, one. That said,
6:46science must be explained well, let's
6:48say explained in full, because many
6:50other muscarinic drugs stumbled later
6:52in the registration trials, the ones
6:54that are supposed to demonstrate
6:55efficacy. The same drug did not yield
6:59the hoped-for results when it was
7:01tested as an add-on to other
7:03antipsychotics. So, enthusiasm yes, but
7:05I would say let's keep our feet on the
7:07ground because these are experimental
7:09drugs that objectively still need to be
7:12very thoroughly tested in
7:13post-marketing studies. This is
7:15important. What else do we have? Well,
7:17you all expect me to talk about
7:18psychedelia. I have already spoken
7:21about it in several dedicated videos,
7:23also in a very critical way, so here I
7:25will only tell you one thing:
7:27psilocybin for treatment-resistant
7:29depression has completed phase 3 trials
7:31and an application for FDA approval is
7:33underway. LSD in pharmaceutical
7:36formulation has given quite positive
7:38results in phase 3 for anxiety and
7:41depression. Depressive symptoms—it
7:43would be nice to better understand what
7:45and in what way. And furthermore, in
7:482025, AbbVie, one of the largest
7:50pharmaceutical companies in the world,
7:53put up to 1.2 billion dollars on the
7:55table to acquire a short-acting
7:57psychedelic. I must say that this is a
8:01good thing on one hand. Larger, more
8:04rigorous studies, clear rules, and
8:06access for patients who want many of
8:07their new drugs. On the other hand,
8:11however, that slightly naive, slightly
8:13hippie, and even idealistic world that
8:15kept research—or rather, the spirit
8:17of psychedelia—alive for decades,
8:19when no one believed in it, risks being
8:21completely absorbed and denatured by
8:23Big Pharma. So, moving to the other
8:27side of the barricade, because
8:28industrial logic pushes toward
8:30patentable molecules, not toward
8:32psychedelic-assisted psychotherapy:
8:34therefore sessions are increasingly
8:35shorter or absent, and in some cases,
8:37even toward compounds that promise an
8:40antidepressant effect without, let's
8:41call it, the trip—therefore in the
8:43absence of a psychedelic effect. I mean
8:47, it's all legitimate, all very
8:49interesting, let's call it, worth doing
8:52, but the heart of the psychedelic
8:54renaissance, from my point of view, is
8:56very, very distorted, in the sense that
8:59the idea was that the substance alone
9:01wasn't enough, that what mattered were
9:03the interventions, let's call them
9:05psychotherapeutic, under psychedelics.
9:09That the therapeutic relationship
9:10mattered, the setting, the integration
9:12of the experience. Well, that part
9:15isn't patentable, and in my opinion,
9:17since it’s not a scalable part, I
9:19guarantee you it will be forgotten, and
9:21we'll be left with new
9:22psychopharmaceuticals, let’s call
9:24them psychedelics, without the spirit
9:26of psychedelia. This is my opinion.
9:29I've written and said it in a thousand
9:30articles, a thousand other videos, go
9:31watch them. This brings us to what I
9:34think is the most important point of
9:36this entire video: even with all these
9:37new molecules, the future of psychiatry
9:39will increasingly move toward
9:40multimodal treatments. This is the
9:45success of psychiatry, if there is to
9:47be success: that is, medication, but
9:49also psychotherapy, psychoeducation,
9:51lifestyle medicine, lifestyle—all
9:53thought of together as part of the same
9:56project and, furthermore, let me add,
9:58environmental modifications, as it’s
10:00currently becoming an increasing
10:02generator of mental suffering, this
10:04unnatural, accelerated, dystopian world
10:06we are living in. Let me give you an
10:10example I know super well: adult ADHD,
10:11where medication can make a huge
10:13difference, but. We see it every day,
10:16it's true, in some people (70%to be
10:18exact), but alone it doesn't teach you
10:19how to organize a day, it doesn't
10:21repair years of damaged self-esteem, it
10:23doesn't make you understand how your
10:25mind works, it doesn't increase
10:26awareness, it doesn't change an
10:27environment, or generally, the
10:29relationships that cause you difficulty
10:31. There you need, I repeat,
10:34psychoeducation, cognitive-behavioral
10:36interventions, mindfulness, practical
10:38strategies, coaching, coaching, and
10:40coaching. I am a huge advocate of
10:42serious coaching, done by psychologists
10:44and psychotherapists who know what they
10:46are doing. And, of course, lifestyle
10:49medicine. You know, in fact, the best
10:52results come when all these pieces work
10:54together, and the coaching approach is
10:56more interesting because one can decide
10:58to reach the finish line with a precise
11:00goal. The same point can be made, I
11:03don't know, for others—not a
11:05neurodivergence, but a classic
11:06psychopathology, let's say, bipolar
11:08disorder; the mood stabilizer remains
11:10the pillar, lithium. Nobody questions
11:13that, but we know that psychoeducation,
11:15the family approach, all psychotherapy
11:17reduces relapses; regularity of rhythms
11:19, sleep, steps, schedules, social
11:20activities, are integral parts of the
11:22treatment. Lifestyle medicine is also
11:26fundamental in bipolar disorder. The
11:28same goes for depression, OCD, and so
11:30on and so forth. So, what psychotropic
11:32drugs should we expect? As I told you,
11:35drugs that work on glutamate, GABA, and
11:38acetylcholine, plus repurposed
11:40psychedelics—we’ll see if they
11:43become psychedelic journeys or simply,
11:45uh, mundane medications. Uh, the real
11:49question, the one I invite you to
11:50reflect on now, I’d say is another.
11:53As always, uh, will we be able to
11:56integrate all these drugs into
11:58treatment paths that view the person in
12:01their entirety and all dimensions of
12:03mental health? Or will we keep looking
12:07for the magic pill, this damn magic
12:09pill that we know doesn't exist? Uh,
12:12will we manage to become people who
12:14create therapeutic paths rather than
12:17looking for the magic pill? We'll see,
12:19uh, we'll see, we'll see. I'm a bit
12:22pessimistic. Well, I hope this topic
12:24was also useful, and as always, I
12:25remind you that this video is purely
12:27for informational purposes and in no
12:29way replaces talking to a specialist.
12:32If you wish to receive information on
12:33diagnostic evaluations or therapeutic
12:35paths, you can find more information in
12:37the description below. That's all for
12:39today as well. If I’ve been helpful,
12:41leave me a like, subscribe to the
12:42channel, turn on the bell notification;
12:43best regards, and we'll see each other
12:45soon to talk about a new topic. Bye.
12:46Bye.

About this transcript

This page contains the full transcript of Quali nuovi psicofarmaci dobbiamo aspettarci nel futuro by Dott. Valerio Rosso, generated from the public captions YouTube serves with the video. The transcript has 1,971 words across 340 segments, with the original timestamps preserved so you can click any line to jump to that moment in the embedded player.

What you can do with it

Use the transcript to take notes, quote the speaker, build a study guide, generate a summary with ChatGPT or Claude via the YouTube Summary tool, or export it as a timed subtitle file with YouTube to SRT. You can also re-open it in the transcriber to translate the transcript into 100+ languages.

Free YouTube transcript tool

YouTube2Text is a free YouTube transcript generator — no signup, no daily limit. Paste any YouTube link and get the full transcript instantly, with timestamps, click-to-jump, translation to 100+ languages, AI prompts for ChatGPT, Claude, and Gemini, and exports to TXT, SRT, VTT, or Markdown.