Mode of action of mood stabilizers: is the arachidonic acid cascade a common target?

Mol Psychiatry. 2008 Jun;13(6):585-96. doi: 10.1038/mp.2008.31. Epub 2008 Mar 18.

Abstract

Bipolar disorder is a major medical, social and economic burden worldwide. However, the mechanisms of action of effective antibipolar disorder drugs remain elusive. In this paper, we review studies using a neuropharmacological approach in unanesthetized rats, combined with kinetic, biochemical and molecular biology techniques, showing that chronic administration of three Food and Drug Administration-approved mood stabilizers (lithium, valproate and carbamazepine) at therapeutically relevant doses, selectively target the brain arachidonic acid (AA) cascade. Whereas chronic lithium and carbamazepine decrease the binding activity of activator protein-2 and in turn the transcription, translation and activity of its AA-selective calcium-dependent phospholipase A(2) gene product, valproate appears to be a non-competitive inhibitor of long-chain acyl-CoA synthetase. The net overlapping effects of the three drugs are decreased turnover of AA but not of docosahexaenoic acid in rat brain phospholipids, and decreased brain cyclooxygenase-2 and prostaglandin E(2). Although these observations support the hypothesis proposed by Rapoport and colleagues that the AA cascade is a common target of mood stabilizers, this hypothesis is not necessarily exclusive of other targets. Targeting the AA cascade with drugs or diet may be a useful therapeutic approach in bipolar disorder, and examining the AA cascade in patients might help in better understanding the disease.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antimanic Agents / therapeutic use*
  • Arachidonic Acid / blood
  • Arachidonic Acid / metabolism*
  • Bipolar Disorder / blood
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / metabolism
  • Brain / drug effects
  • Brain / metabolism
  • Carbamazepine / therapeutic use
  • Humans
  • Lithium / therapeutic use
  • Valproic Acid / therapeutic use

Substances

  • Antimanic Agents
  • Arachidonic Acid
  • Carbamazepine
  • Valproic Acid
  • Lithium