The emerging differential roles of GABAergic and antiglutamatergic agents in bipolar disorders.
Treatment options to relieve the diverse symptoms encountered in patients with bipolar disorders include not only mood stabilizers, but also anxiolytics, new anticonvulsants, antidepressants, and antipsychotics. These agents have widely varying mechanisms of action, which could contribute to the heterogeneity of clinical effects seen in practice. Several of these medications, especially those with anticonvulsant effects, enhance gamma-aminobutyric acid (GABA) inhibitory neurotransmission and/or attenuate glutamate excitatory neurotransmission. We review the efficacy and tolerability of these diverse treatment options in bipolar disorders and explore possible relationships between clinical effects and GABAergic and antiglutamatergic mechanisms of action.
Ketter
Terence A
TA
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Calif 94305, USA. tketter@stanford.edu
Wang
Po W
PW
D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D018683:Excitatory Amino Acid Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018682:GABA Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D009435:Synaptic Transmission / Q000187:drug effects / Q000502:physiology; D005680:gamma-Aminobutyric Acid / Q000187:drug effects / Q000502:physiology
D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018683:Excitatory Amino Acid Agents; D018682:GABA Agents; D005680:gamma-Aminobutyric Acid