Medications for bipolar disorders: a review of their therapeutic and pharmacological differences. Part II: from sinapse to genes

Abstract

From the neurobiochemical point of view, several alterations have been proposed to explain the symptomatology of bipolar disorders, from the classic concept of adrenergic-cholinergic imbalance to other more recent ones, such as the intraneuronal decrease of sodium, the elevation of free intracellular Ca⁺⁺ and elevations of the levels of intraneuronal proteins such as inositol triphosphate, type C protein kinases and others.

All mood euthymics and/or stabilizers require several days or week to show a therapeutic response. Although some of these medications offer rapid control of agitation and insomnia, their mechanism of action involves several intraneuronal mechanisms which go beyond the blocking or agonism of certain receptors .

Although the exact mechanism of the therapeutic response of these medications is not yet known, recent information highlights the importance of the intraneuronal mechanisms of the translation and transcription of neuronal signals which facilitate signal integration through multiple time scales, the ge n e ration of different responses according to the intensity and duration of the stimulus, and the regulation of intricate feedback pathways.

This review states, in summarized form, the results of research on the mechanisms of action of lithium and anticonvulsants, as well as the new medications for managing the various phases of bipolar disorders, lamotrigine and olanzapine.