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    Mol Psychiatry. 2008 Jun;13(6):585-96. Epub 2008 Mar 18.

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

    Rao JS, Lee HJ, Rapoport SI, Bazinet RP.

    Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA.

    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.

    PMID: 18347600 [PubMed - indexed for MEDLINE]

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    Patient drug information

    • Lithium (Eskalith CR®, Eskalith®, Lithobid®)

      Lithium is used to treat and prevent episodes of mania (frenzied, abnormally excited mood) in people with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and ...

    • Carbamazepine (Carbatrol®, Epitol®, Equetro®, ...)

      Carbamazepine is used alone or in combination with other medications to control certain types of seizures. It is also used to treat trigeminal neuralgia (a condition that causes facial nerve pain). Carbamazepine extended...

    • Valproic Acid (Depakene®, Depakote®, Depakote® ER, ...)

      Valproic acid is used alone or with other medications to treat certain types of seizures. Valproic acid is also used to treat mania (episodes of frenzied, abnormally excited mood) in people with bipolar disorder (manic-d...