The 5-HT1B receptor， one of the serotonin（ 5-HT） receptors， serves as a key regulatory factor in the central nervous system. Owing to its dual nature as both an autologous and heterologous receptor， it exhibits spatiotemporal expression heterogeneity and functional duality across different brain regions， cell types， and neural circuits， acting as a "multifunctional switch" involved in the pathophysiological mechanisms of various neuropsychiatric disorders. This review systematically elucidates the complex roles of the 5-HT1B receptor in conditions such as depressive disorders， anxiety disorders， substance use disorders， impulsive aggressive behaviors， Parkinson's disease， and migraine. Existing medications， such as triptans and vortioxetine， have demonstrated their preliminary therapeutic potential. Future research should integrate multi-omics with precision intervention technologies to construct spatiotemporal dynamic functional maps and develop functionally selective ligands， thereby advancing the implementation of personalized treatment strategies.