PSP involves impairment of multiple neurotransmitter systems, and the use of neurotransmitter replacement therapy is the basis of clinical treatment. Cholinesterase inhibitors, toxopamine, and acetylcholine enhancers have not shown significant efficacy.Nieforth et al. conducted a retrospective analysis of treatment options for 136 diagnosed PSP cases, of which 87 cases provided the material for analysis, and concluded that three drugs were commonly used: amitriptyline (improved in 32% of cases); promethazine (improved in 28% of cases); levodopa/carbidopa ( Gole et al. used placebo-controlled and cross-controlled methods to observe the treatment of 9 patients with PSP with the adrenergic enhancer idaxoxam, in which 5 cases had balance disorders and Engel described in detail the effect and dose of amitriptyline treatment in two PSP patients and concluded that motor disorders were improved at low doses of amitriptyline treatment, and toxic side effects such as intellectual and behavioral disorders occurred at high doses. A 65-year-old male patient was treated with 11 wk of amitriptyline in slowly increasing doses to improve hypermobility, dysarthria, and dysphagia at a dose of 40 mg bid and a blood level of 39 ng/ml. When the dose was increased to 70 mg bid, nocturnal mental disturbances and difficulty in urination occurred. A further reduction to 40 mg bid resulted in symptom relief lasting 14 months. Another 77-year-old male PSP patient on 10 mg bid showed significant improvement in tonicity, hyperkinesia, balance disorder and blepharospasm, and was able to eat on his own and walk unaided, but when the dose was increased to 40 mg bid with a blood concentration of 62 ng/ml for 3 wk, he developed aggressive behavior, irritability and psychosis. The symptoms improved again when the dose was 10 mg Bid. The results suggest that small doses of amitriptyline can improve the symptoms of motor disorders in PSP patients, but the dose should be individualized. It has also been suggested that the combination of levodopa and 5-hydroxytryptamine receptor blockers can help improve the patient’s response to levodopa treatment. Dimethyl ergometrine (methysergide) may improve dysphagia in some patients.