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However there are also nicotinic receptors, as well as M1 and M5 (Soto et al, 2013).In the CNS, the N or P/Q type are the ones that participate in neurotransmitter release.There are at least four major neurotransmitters of the vestibular system involved in the "three neuron arc" between the vestibular hair cells and oculomotor nuclei that drives the vestibulocular reflex.There are also a host of other neurotransmitters which modulate function.Glutamate is the major excitatory neurotransmitter at vestibular afferents (Serafin et al, 1992) as well as with neurons of the vestibular nuclei (where they may also release aspartate).Glutamate interacts with several subreceptors including NMDA, AMPA, and KA, and metabotrophic receptors (Soto et al, 2013).Serotonin receptors are also found in the vestibular nerve and vestibular nucleus (5HT-1, 2 and 7, according to Soto et al, 2013), but the functional significance of this uncertain (Ahn and Balaban, 2010). Withdrawall from serotonergic drugs, such as SSRI antidepressants, is commonly associated with vertigo, and serotonin depletion can cause severe dizziness (Soto et al, 2013).It has been speculated that this is due to loss of inhibition of glutamate -- in other words, increased vestibular responses as glutamate is excitatory (Smith PF, Darlington CL, 2010).

which affect muscarinic receptors, such as scopolamine, increase motion tolerance.

Examples are meclizine, dimenhydrinate, and diphenhydramine. Agents with central anticholinergic effects are most important in treating vertigo, since anticholinergic drugs that do not cross the blood-brain barrier are ineffective in controlling motion sickness (Takeda et al, 1989).

Unlike antihistamines which will be discussed subsequently, pure anticholinergics are ineffective if administered after symptoms have already appeared.

Dopamine affects vestibular compensation, and serotonin is involved with nausea.

is also produced in the vestibular nucleus, and may play a role in compensation (Soto, 2013).




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