Pathophysiologische Erklärungsansätze bipolarer Störungen - Was kann uns der Wirkmechanismus von Stimmungsstabilisierern verraten?

Zusammenfassung

Spätestens seit der klassifikatorischen Erweiterung durch DSM IV und ICD 10 in Richtung eines bipolaren Spektrums kann man annehmen, dass bipolare Störungen nicht nur klinisch heterogen sind, sondern auch unterschiedliche Mechanismen der Erkrankung zugrunde liegen können. Dennoch gibt es einige übergreifende Prinzipien, die bei der Regulierung der neuronalen Erregbarkeit, aber auch bei der Überlebensfähigkeit der Neurone eine tragende Rolle spielen. Hier sind zugleich Angriffspunkte der im klinischen Alltag am häufigsten eingesetzten Stimmungsstabilisierer, wie Lithium, Carbamazepin, Valproat oder Lamotrigin. Der Wirkmechanismus dieser Substanzen lässt zumindest indirekte Schlüsse zu, welche Störungen auf zellulärer Ebene den bipolaren Störungen zugrunde liegen könnten.

Abstract

Not ever since the broadening of diagnosis towards bipolar spectrum disorder with DSM IV and ICD-10 at the latest, we should assume that bipolar disorders are not only clinically heterogeneous, but may have a diversity of underlying pathophysiological disturbances. However, there are some general principles which are of importance both for the regulation of neuronal excitability and neuronal survival. They may also constitute the main targets of clinically used mood stabilisers as lithium, carbamazepine, valproate and lamotrigine. The mechanisms of action of these substances may give us at least indirect hints for the underlying cellular disturbances in bipolar disorders.

Schlüsselwörter

Bipolare Störungen - Lithium - Valproat - Lamotrigin - Spannungsabhängige Ionenkanäle - Zytoprotektive Proteine

Key words

Bipolar disorders - Lithium - Valproate - Lamotrigine - Voltage-gated ion channels - Cytoprotective proteins

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