Bipolar Medications : Mechanisms of Action

From our regular book review column.

Mogens Schou, when recently asked why he had spent almost his entire scientific life focused on lithium, stated that there was so much to find out about it he saw no reason to turn to other topics. Although over 50 years have elapsed since John Cade’s initial observations, the mechanism of lithium’s remarkably specific therapeutic effects in bipolar mood disorder has remained elusive. Recently, however, there has been a convergence of evidence that suggests that a breakthrough in understanding may be imminent. The clinical usage of novel anticonvulsant drugs such as lamotrigine, gabapentin, and topiramate, among others, has kindled a resurgent effort to identify biological actions that might link these agents to lithium, valproic acid, and carbamazepine and possibly illuminate the underlying pathophysiology of manic-depressive illness.