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Emerging experimental therapeutics for bipolar disorder: clues from the molecular pathophysiology

Molecular Psychiatry volume 9, pages 756–776 (2004)Cite this article

Abstract

Bipolar affective disorder (manic-depressive illness) is a common, severe, chronic, and often life-threatening illness, associated with significant comorbidity. The recognition of the significant morbidity and mortality of patients with bipolar disorder, as well as the growing appreciation that a high percentage of patients respond poorly to existing treatments, has made the task of discovering new therapeutic agents, that are both efficacious and have few side effects increasingly more important. Most recent agents introduced into the pharmacopeia for the treatment of bipolar disorder have been anticonvulsants and atypical antipsychotics. We propose that novel treatments developed specifically for bipolar disorder will arise from (1) understanding more precisely the molecular mechanisms of treatments that are clearly efficacious or (2) developing medications based on the knowledge obtained of the underlying pathophysiology of bipolar disorder. Knowledge with regard to the underlying pathophysiology of bipolar disorder is increasing at a rapid pace, including alterations in intracellular signaling cascades as well as impairments of cellular plasticity and resilience in critical neuronal circuits. We propose that therapeutics designed to enhance cellular plasticity and resilience and that counter maladaptive stress-responsive systems may have considerable utility for the treatment of bipolar disorder. Therapeutic strategies designed to address cellular resilience and plasticity include the regulation of neurotrophic pathways, glucocorticoid signaling, phosphodiesterase activity, and glutamatergic throughput and mitochondrial function. While the task of developing novel medications for bipolar disorder is truly daunting, these and similar approaches will ultimately lead to better medications for the millions who suffer from this devastating illness.

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Acknowledgements

We acknowledge the support of the Intramural Research Program of the National Institute of Mental Heath and the Stanley Medical Research Institute. TDG is supported by Foundation for NIH Fellowship. JAQ and TDG are supported by NARSAD Young Investigators Awards. Owing to space limitations, we often cited review papers and apologize to those authors whose original data could not be included.

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  1. Laboratory of Molecular Pathophysiology, National Institute of Mental Health, Bethesda, MD, USA

    J A Quiroz, J Singh, T D Gould, K D Denicoff, C A Zarate Jr & H K Manji

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  1. J A Quiroz
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  2. J Singh
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  3. T D Gould
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  4. K D Denicoff
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  5. C A Zarate Jr
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  6. H K Manji
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Correspondence to H K Manji.

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Quiroz, J., Singh, J., Gould, T. et al. Emerging experimental therapeutics for bipolar disorder: clues from the molecular pathophysiology. Mol Psychiatry 9, 756–776 (2004). https://doi.org/10.1038/sj.mp.4001521

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  • DOI: https://doi.org/10.1038/sj.mp.4001521

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