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Early-Onset Bipolar Disorder 329been used for other psychiatric disorders: During times of trauma, SSRIs havebeen proposed to reduce or prevent symptoms of PTSD (Martenyi, Brown, Zhang,Prakash, & Koke, 2002), and antipsychotics have been used successfully to treatrelatives of schizophrenic probands with subsyndromal symptomatology andadolescents with early signs of schizophrenia (Cannon et al., 2002; Tsuang, Stone,& Faraone, 2002). Therefore, one might consider mood stabilizers and atypicalantipsychotics to be the class of medications to be used for prevention of BD.However, effects of medications on acute symptoms may differ from their potentialto prevent worsening of pathology. Perhaps, then, medications proven usefulin relapse prevention in BD (lithium, valproate, lamotrigine, olanzapine, andaripiprazole) would be good candidates. The term “neuroprotection” is often usedwhen discussing such medications that could prevent worsening of BD, or in ourcase, development of first-episode mania.NeuroprotectionAlthough psychotropic medications have been studied for their acute therapeuticproperties and adverse effects profile, less is known about their neuroprotectivecharacteristics. For this discussion, we will consider the concept of neuroprotectionat four different levels: protection of brain tissue against injury or death (trueneuroprotection), prevention of onset of a seizure disorder (antikindling properties),indirect promotion of neuronal survival or growth by activation of neurotrophicfactors or inhibition of neurotoxic pathways at the cellular level, ordetectable creation of new neurons (neurogenesis).Anticonvulsants specifically have long been thought to have true neuroprotectivequalities. Primarily, these qualities have been determined by animalstudies in which animals given these medications have reduced areas of braininfarction following an induced stroke or other neurotoxic procedure. Typically,the infarction is caused by the resulting loss of tissue oxygenation, or ”ischemia.”Findings of this type of neuroprotection have been most positive for topiramate(Kudin, Debska-Vielhaber, Vielhaber, Elger, & Kunz, 2004; Yang, Shuaib, Li,& Siddiqui, 1998), lamotrigine (Calabresi et al., 2003; Shuaib et al., 1995), andtiagabine (Inglefield, Perry, & Schwartz, 1995; Yang, Li, Wang, Jeerakathil, &Shuaib, 2000). Weaker evidence has been found for felbamate, leviteracetam,tiagabine, and zonisamide (Leker & Neufeld, 2003). Barbituates, benzodiazepines,valproate, phenytoin, and carbamazepine do not appear to be good candidatesfor ischemia prevention due to lack of efficacy or negating effects ofcerebral blood flow reduction (Leker & Neufeld, 2003). Of the atypical antipsychotics,which have been less studied for neuroprotection, olanzapine wasfound to protect neuronal cells from oxidation with hydrogen peroxide (Wei,Bai, Richardson, Mousseau, & Li, 2003). Although these findings are intriguing,this type of neuroprotection may be less relevant to diseases with nonischemicmodels of neuronal insult, such as BD.