Mood stabilizers: anticonvulsants

Mood stabilizers represent a class of drugs that are used in the treatment of bipolar disorder, as prophylactic agents against future episodes and as adjunctive antidepressant medication. The anticonvulsant drugs such as valproic acid and carbamazepine are efficacious drugs in the treatment of epilepsy and bipolar disorder. Regarding the way that these drugs exhibit their therapeutic effect in the above disorders, many mechanisms have been postulated. Among them regulation of the glutamate excitatory neurotransmission and GABA inhibitory neurotransmission are mostly studied mechanisms of anticonvulsants. Quite important extracellular effects of these drugs have not been excluded, as most available evidence suggests that the therapeutically relevant class of medications are in the interior of the cells. The mood stabilizers have been shown to modulate the activity of enzymes, ions, arachidonic acid turn over, G-protein coupled receptors and intracellular pathways involved in synaptic plasticity and neuroprotection. Understanding the therapeutic targets of mood stabilizers will undoubtedly lead to a better understanding of the pathophysiology of bipolar disorder and to the development of improved therapeutics for the treatment of this disease.