title: Future Directions for Pharmacotherapies for Treatment-resistant Bipolar Disorder.
abstract: Current pharmacological treatments for bipolar disorder (BD) are limited and efficacy has historically been discovered through serendipity. There is now scope for new drug development, focused on the underlying biology of BD that is not targeted by current therapies. The need for novel treatments is urgent when considering treatment resistant BD, where current therapies have failed. While established drugs targeting the monoamine systems continue to be worthwhile, new biological targets including inflammatory and oxidative an nitrosative pathways, apoptotic and neurotrophic pathways, mitochondrial pathways, the N-methyl-Daspartate (NMDA)-receptor complex, the purinergic system, neuropeptide system, cholinergic system and melatonin pathways are all being identified as potential anchors for the discovery of new agents. Many agents are experimental and efficacy data is limited, however further investigation may provide a new line for drug discovery, previously stalled by lack of corporate interest.
authors.forename: Seetal
authors.initials: S
authors.lastname: Dodd
authors.forename: Brisa S
authors.initials: BS
authors.lastname: Fernandes
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.
authors.forename: Olivia M
authors.initials: OM
authors.lastname: Dean
mesh_terms: D000818:Animals; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000378:metabolism; D018678:Cholinergic Agents / Q000627:therapeutic use; D055808:Drug Discovery; D006801:Humans; D009479:Neuropeptides / Q000378:metabolism; D058905:Purinergic Agents / Q000627:therapeutic use; D016194:Receptors, N-Methyl-D-Aspartate / Q000819:agonists / Q000037:antagonists & inhibitors / Q000378:metabolism
chemical_list: D000928:Antidepressive Agents; D018678:Cholinergic Agents; D009479:Neuropeptides; D058905:Purinergic Agents; D016194:Receptors, N-Methyl-D-Aspartate