The serotonin 1A receptor (5-HT 1A R) is implicated in the pathophysiology of a variety of neuropsychiatric and neurodegenerative disorders (1). The antagonist radiotracer [ 11 C]WAY100635 has been the most commonly used 5-HT 1A ligand for in vivo Positron Emission Tomography (PET) studies (2). However, being a noncompetitive antagonist at the 5-HT 1A R, it has equal affinity for high agonist (HA) and low agonist (LA) affinity sites of the receptors and therefore cannot detect changes in the ratio of these sites or changes specific to high agonist affinity sites. In contrast, agonists bind preferentially to the HA state of the receptor, thereby providing a more functionally meaningful measure of the 5-HT 1A R. This hypothesis is supported by the finding that in vitro agonist binding measured by [ . Theoretically, the failure of the system to adjust or maintain the necessary ratio of HA and LA affinity site of receptors may be an important factor in the pathophysiology of several diseases. Obtaining PET scans with both an agonist and antagonist ligand in the same subject enables the quantification of not only the binding to active or Gprotein-coupled receptors (GPCR), but also the ratio of active vs. inactive receptors, which may change without any change in the total binding. Importantly, this ratio determines the number of active receptors or the efficacy of 5-HT transmission by endogenous 5-HT. Moreover, an agonist 5-HT 1A radiotracer is likely to be sensitive to displacement by the endogenous agonist of the receptor and therefore may be useful as a biomarker to measure the changes in the intra-synaptic concentrations of the endogenous 5-HT, to monitor desensitization (down regulation) and sensitization (up regulation) of GPCRs, to provide a better estimate of receptor occupancy for agonist therapeutic agents, and for evaluation of the efficacy of SSRI treatment. However, no in vivo data have been published for a comparison of agonist and antagonist 5-HT 1A tracers as a proof of principle for measurement of high and low affinity states of this receptor. We have recently reported that [11 C]CUMI-101, a 5-HT 1A partial agonist radiotracer (K i = 0.15 nM, E max = 80%), can quantify 5-HT 1A binding with PET in nonhuman primates and human subjects (6 -8 Psychiatry and Behavioral Medicine, Stony Brook University, Stony Brook, NY 11794, USA Received April 22, 2012; Accepted September 7, 2012 Abstract. Serotonin (5-HT) 1A receptors exist in high and low affinity states. Agonist ligands bind preferentially to the high affinity state receptors, providing a more functionally relevant measure than antagonist binding. We now report comparison of 5-HT 1A binding in vivo using both