Dopamine dysregulation syndrome: implications for a dopamine hypothesis of bipolar disorder.
OBJECTIVE
Rational therapeutic development in bipolar is hampered by a lack of pathophysiological model. However, there is a wealth of converging data on the role of dopamine in bipolar disorder. This paper therefore examines the possibility of a dopamine hypothesis for bipolar disorder.


METHODS
A literature search was conducted using standard search engines Embase, PyschLIT, PubMed and MEDLINE. In addition, papers and book chapters known to the authors were retrieved and examined for further relevant articles.


RESULTS
Collectively, in excess of 100 articles were reviewed from which approximately 75% were relevant to the focus of this paper.


CONCLUSIONS
Pharmacological models suggest a role of increased dopaminergic drive in mania and the converse in depression. In Parkinson's disease, administration of high-dose dopamine precursors can produce a 'maniform' picture, which switches into a depressive analogue on withdrawal. It is possible that in bipolar disorder there is a cyclical process, where increased dopaminergic transmission in mania leads to a secondary down regulation of dopaminergic receptor sensitivity over time. This may lead to a period of decreased dopaminergic transmission, corresponding with the depressive phase, and the repetition of the cycle. This model, if verified, may have implications for rational drug development.
Berk
M
M
Department of Clinical and Biomedical Sciences, Barwon Health and The Geelong Clinic, University of Melbourne, Geelong, Victoria, Australia. mberk@unimelb.edu.au
Dodd
S
S
Kauer-Sant'anna
M
M
Malhi
G S
GS
Bourin
M
M
Kapczinski
F
F
Norman
T
T
D000339:Affect / Q000187:drug effects / Q000502:physiology; D001714:Bipolar Disorder / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology*; D004298:Dopamine / Q000502:physiology*; D015259:Dopamine Agents / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology; D049268:Positron-Emission Tomography; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology; D009435:Synaptic Transmission / Q000187:drug effects / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon
D015259:Dopamine Agents; D004298:Dopamine