Mood Stabilizers Target Cellular Plasticity and Resilience Cascades: Implications for the Development of Novel Therapeutics

Laboratory of Molecular Pathophysiology, National Institute of Mental Health, Bethesda, MD, USA.
Molecular Neurobiology (Impact Factor: 5.14). 11/2005; 32(2):173-202. DOI: 10.1385/MN:32:2:173
Source: PubMed


Bipolar disorder is a devastating disease with a lifetime incidence of about 1% in the general population. Suicide is the cause of death in 10 to 15% of patients and in addition to suicide, mood disorders are associated with many other harmful health effects. Mood stabilizers are medications used to treat bipolar disorder. In addition to their therapeutic effects for the treatment of acute manic episodes, mood stabilizers are useful as prophylaxis against future episodes and as adjunctive antidepressant medications. The most established and investigated mood-stabilizing drugs are lithium and valproate but other anticonvulsants (such as carbamazepine and lamotrigine) and antipsychotics are also considered as mood stabilizers. Despite the efficacy of these diverse medications, their mechanisms of action remain, to a great extent, unknown. Lithium's inhibition of some enzymes, such as inositol monophosphatase and glycogen synthase kinase-3, probably results in its mood-stabilizing effects. Valproate may share its anticonvulsant target with its mood-stabilizing target or may act through other mechanisms. It has been shown that lithium, valproate, and/or carbamazepine regulate numerous factors involved in cell survival pathways, including cyclic adenine monophospate response element-binding protein, brain-derived neurotrophic factor, bcl-2, and mitogen-activated protein kinases. These drugs have been suggested to have neurotrophic and neuroprotective properties that ameliorate impairments of cellular plasticity and resilience underlying the pathophysiology of mood disorders. This article also discusses approaches to develop novel treatments specifically for bipolar disorder.

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    • "Based on this , a hypothesis was drawn that neuroplasticity dysfunction and cellular resilience formed an important component of the bipolar disorder . With use of clinically effective mood stabilizers such as lithium and valproic acid this approach was utilized ( Bachmann et al . , 2005 ; Schloesser et al . , 2008 ) . Efficacy of this approach has suggested a various intracellular signaling elements like glycogen synthase kinase 3 ß ( GSK3 ß ) , extracellular - signal - regulated kinase ( ERK ) / mitogen - activated protein kinase ( MAPK ) or protein kinase C as the main targets . However , it was found that lamotrigin"
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    ABSTRACT: The efficacy of lamotrigine in the treatment of focal epilepsies have already been reported in several case reports and open studies, which is thought to act by inhibiting glutamate release through voltage-sensitive sodium channels blockade and neuronal membrane stabilization. However, recent findings have also illustrated the importance of lamotrigine in alleviating the depressive symptoms of bipolar disorder, without causing mood destabilization or precipitating mania. Currently, no mood stabilizers are available having equal efficacy in the treatment of both mania and depression, two of which forms the extreme sides of the bipolar disorder. Lamotrigine, a well established anticonvulsant has received regulatory approval for the treatment and prevention of bipolar depression in more than 30 countries worldwide. Lamotrigine, acts through several molecular targets and overcomes the major limitation of other conventional antidepressants by stabilizing mood from "below baseline" thereby preventing switches to mania or episode acceleration, thus being effective for bipolar I disorder. Recent studies have also suggested that these observations could also be extended to patients with bipolar II disorder. Thus, lamotrigine may supposedly fulfill the unmet requirement for an effective depression mood stabilizer.
    Frontiers in Pharmacology 11/2015; 6:242. DOI:10.3389/fphar.2015.00242 · 3.80 Impact Factor
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    • "Psychotic disorders, including schizophrenia and bipolar disorder, are debilitating mental illnesses that lead to progressive deterioration in the social and occupational functioning of individuals,1,2) and increased economic burden of the society.3,4) Methamphetamine, a central nervous system stimulant, is the most commonly abused drug in Korea as well as other parts of East Asia.5,6,7) "
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    ABSTRACT: Objective It was previously suggested that the malic enzyme 2 (ME2) as the candidate gene for psychosis in fine mapping of chromosome 18q21. Chromosome 18q21 is also one of the possible regions that can contribute to addiction. Methods We performed a pilot study for discovering candidate gene of chromosome 18q21 in the methamphetamine abusers for elucidating the candidate gene for methamphetamine addiction leading to psychosis. We have selected 30 unrelated controls (16 males, 14 females; age=59.8±10.4) and 37 male methamphetamine abusers (age=43.3±7.8). We analyzed 20 single nucleotide polymorphisms (SNPs) of 7 neuronal genes in chromosome 18q21 for DNA samples that was checked for the data quality and genotype error. The association between the case-control status and each individual SNP was measured using multiple logistic regression models (adjusting for age and sex as covariates). And we controlled false discovery rate (FDR) to deal with multiple testing problem. Results We found 3 significant SNPs of 2 genes in chromosome 18q21 (p-value<0.05; adjusting for age as covariate) in methamphetamine abusers compared to controls. We also found 2 significant SNPs of 1 gene (p-value<0.05; adjusting for age and sex as covariates) (rs3794899, rs3794901:MAPK4). Two SNPs in MAPK4 gene were significant in both statistical groups. Conclusion MAPK4, the gene for mitogen-activated protein kinase 4, is one of the final 6 candidate genes including ME2 in 18q12-21 in our previous finemapping for psychosis. Our results suggest that MAPK4 can be a candidate gene that contribute to the methamphetamine addiction leading to psychosis.
    Clinical Psychopharmacology and Neuroscience 04/2014; 12(1):54-64. DOI:10.9758/cpn.2014.12.1.54
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    • "Evolving theories supported by molecular, cellular, and behavioral data suggest that affective disorders might be neurodegenerative disorders that involve cascades controlling plasticity and resilience (Bachmann et al. 2005; Einat and Manji 2006; Racagni and Popoli 2008; Calabrese et al. 2009). "
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    ABSTRACT: RATIONALE: The disaccharide trehalose protects cells from hypoxic and anoxic injury and suppresses protein aggregation. In vivo studies with trehalose show cellular and behavioral beneficial effects in animal models of neurodegenerative diseases. Moreover, trehalose was shown to enhance autophagy, a process that had been recently suggested to be involved in the therapeutic action of antidepressant and mood-stabilizing drugs. OBJECTIVE: The present study was therefore designed to explore antidepressant and mood-stabilizing activity of trehalose in animal models for depression and mania. METHODS: Trehalose 1 or 2 % was administered for 3 weeks as a drinking solution to Black Swiss mice (a model of manic-like behaviors) or 2 % to ICR mice and their behavior evaluated in a number of tests related to depression or mania. The effects of trehalose were compared with similar chronic administration of the disaccharide maltose as well as with a vehicle (water) control. RESULTS: Chronic administration of trehalose resulted in a reduction of frontal cortex p62/beclin-1 ratio suggesting enhancement of autophagy. Trehalose had no mood-stabilizing effects on manic-like behavior in Black Swiss mice but instead augmented amphetamine-induced hyperactivity, an effect similar to antidepressant drugs. In ICR mice, trehalose did not alter spontaneous activity or amphetamine-induced hyperactivity but in two separate experiments had a significant effect to reduce immobility in the forced swim test, a standard screening test for antidepressant-like effects. CONCLUSIONS: The results suggest that trehalose may have antidepressant-like properties. It is hypothesized that these behavioral changes could be related to trehalose effects to enhance autophagy.
    Psychopharmacology 09/2013; 229:367-375. DOI:10.1007/s00213-013-3119-4 · 3.88 Impact Factor
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