5-HTPvsEmoxypine (Mexidol)

5-HTP readily crosses the blood-brain barrier via the large neutral amino acid transporter (LAT1/SLC7A5), unlike serotonin itself which cannot. Once in the brain, aromatic L-amino acid decarboxylase (AADC, also called DOPA decarboxylase) converts 5-HTP to serotonin (5-hydroxytryptamine) using pyridoxal-5-phosphate (active vitamin B6) as a cofactor. This completely bypasses tryptophan hydroxylase (TPH2), the rate-limiting enzyme in the normal serotonin synthesis pathway from dietary L-tryptophan. The result is a reliable, dose-dependent increase in serotonin across multiple brain regions including the dorsal raphe nucleus, hippocampus, and prefrontal cortex. Elevated serotonin activates 5-HT1A autoreceptors (calming), 5-HT2A/2C postsynaptic receptors (mood modulation), and 5-HT3 receptors (gut-brain signaling). In the pineal gland, serotonin is converted by arylalkylamine N-acetyltransferase (AANAT) to N-acetylserotonin, then by hydroxyindole O-methyltransferase (HIOMT) to melatonin — explaining the sleep-promoting effects.

Emoxypine (2-ethyl-6-methyl-3-hydroxypyridine succinate) has a 3-hydroxypyridine structure similar to vitamin B6 (pyridoxine). It is one of the most potent inhibitors of lipid peroxidation in brain tissue — it scavenges hydroxyl radicals and peroxyl radicals, inhibits Fe2+-induced lipid peroxidation, and may chelate transition metals. It modulates the GABA-benzodiazepine receptor complex (GABA-A), enhancing GABAergic transmission through positive allosteric modulation — possibly at a site distinct from the classical benzodiazepine binding site, explaining the lack of sedation and tolerance. It improves mitochondrial function (Complex I protection, membrane stabilization), stabilizes cell membranes (reducing fluidity changes during oxidative stress), and enhances cerebral microcirculation (possibly via nitric oxide or prostaglandin modulation). The anxiolytic mechanism may involve partial agonism or different subunit selectivity.