From neuroprogression to neuroprotection: implications for clinical care.
Bipolar disorder follows a staged trajectory in which persistence of illness is associated with a number of clinical features such as progressive shortening of the inter-episode interval and decreased probability of treatment response. This neuroprogressive clinical process is reflected by both progressive neuroanatomical changes and evidence of cognitive decline. The biochemical foundation of this process appears to incorporate changes in inflammatory cytokines, cortisone, neurotrophins and oxidative stress. There is a growing body of evidence to suggest that these markers may differ between the early and late stages of the disorder. The presence of a series of tangible targets raises the spectre of development of rational neuroprotective strategies, involving judicious use of current therapies and novel agents. Most of the currently used mood stabilisers share effects on oxidative stress and neurotrophins, while novel potentially neuroprotective agents are being developed. These developments need to be combined with service initiatives to maximise the opportunities for early diagnosis and intervention.
Berk
Michael
M
Department of Clinical and Biomedical Sciences-Barwon Health, University of Melbourne, Melbourne, VIC. mikebe@barwonhealth.org.au
Conus
Philippe
P
Kapczinski
Flávio
F
Andreazza
Ana C
AC
Yücel
Murat
M
Wood
Stephen J
SJ
Pantelis
Christos
C
Malhi
Gin S
GS
Dodd
Seetal
S
Bechdolf
Andreas
A
Amminger
G Paul
GP
Hickie
Ian B
IB
McGorry
Patrick D
PD
D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology*; D001921:Brain / Q000033:anatomy & histology / Q000503:physiopathology*; D003072:Cognition Disorders / Q000503:physiopathology; D018450:Disease Progression; D006801:Humans; D008928:Mitochondria / Q000502:physiology; D009414:Nerve Growth Factors / Q000502:physiology; D018696:Neuroprotective Agents / Q000627:therapeutic use; D018384:Oxidative Stress / Q000502:physiology
D018692:Antimanic Agents; D009414:Nerve Growth Factors; D018696:Neuroprotective Agents