Mania and Indomethacin

Bishop, Leigh C.; Bisset, Andrew D.; Benson, John I.

doi:10.1097/00004714-198706000-00032

Cited by 6 publications

(3 citation statements)

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“…Altered levels of prostaglandins have been detected in different body fluids in patients with major affective disorders (23)(24)(25)(26)(27)(28). Also pharmacological evidence (29)(30)(31) suggests that altered prostaglandin metabolism may lead to mood disorders. All this is consistent with episode-specific differential gene expression of PTGDS and AKR1C3 as revealed in the present case.…”

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confidence: 99%

Episode-Specific Differential Gene Expression of Peripheral Blood Mononuclear Cells in Rapid Cycling Supports Novel Treatment Approaches

Begemann

Sargin

Rossner

et al. 2008

Mol Med

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Molecular mechanisms underlying bipolar affective disorders are unknown. Difficulties arise from genetic and phenotypic heterogeneity of patients and the lack of animal models. Thus, we focused on only one patient (n = 1) with an extreme form of rapid cycling. Ribonucleic acid (RNA) from peripheral blood mononuclear cells (PBMC) was analyzed in a three-tiered approach under widely standardized conditions. Firstly, RNA was extracted from PBMC of eight blood samples, obtained on two consecutive days within one particular episode, including two different consecutive depressive and two different consecutive manic episodes, and submitted to (1) screening by microarray hybridizations, followed by (2) detailed bioinformatic analysis, and (3) confirmation of episode-specific regulation of genes by quantitative real-time polymerase chain reaction (qRT-PCR). Secondly, results were validated in additional blood samples obtained one to two years later. Among gene transcripts elevated in depressed episodes were prostaglandin D synthetase (PTGDS) and prostaglandin D2 11-ketoreductase (AKR1C3), both involved in hibernation. We hypothesized them to account for some of the rapid cycling symptoms. A subsequent treatment approach over 5 months applying the cyclooxygenase inhibitor celecoxib (2 × 200 mg daily) resulted in reduced severity rating of both depressed and manic episodes. This case suggests that rapid cycling is a systemic disease, resembling hibernation, with prostaglandins playing a mediator role.

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confidence: 99%

Episode-Specific Differential Gene Expression of Peripheral Blood Mononuclear Cells in Rapid Cycling Supports Novel Treatment Approaches

Begemann

Sargin

Rossner

et al. 2008

Mol Med

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“…Although two rather old studies are indicative that use of some non-steroidal antiinflammatory drugs (NSAIDs) such as indomethacin and tolmetin may exacerbate the associated symptoms of mania, this could be due to their non-selective inhibitory action on both COX-1 and COX-2. However, there is also a case report that COX-2 selective NSAIDs induced hypomania despite maintenance of treatment with mood-enhancing drugs, and symptoms remitted following 3 days of discontinuation of the NSAID (Sotsky & Tossell, 1984;Bishop et al, 1987;Mahajan et al, 2012).…”

Section: Into the Genesmentioning

confidence: 99%

Bipolar disorder and the endocannabinoid system

Arjmand

Behzadi

Kohlmeier

et al. 2019

Acta Neuropsychiatr.

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ObjectiveBipolar disorder (BD) is a debilitating, lifelong neuropsychiatric illness characterised by unsteady mood states which vacillate from (hypo)mania to depression. Despite the availability of pharmaceutical agents which can be effective in ameliorating the acute affective symptoms and prevent episodic relapse, BD is inadequately treated in a subset of patients. The endocannabinoid system (ECS) is known to exert neuromodulatory effects on other neurotransmitter systems critical in governing emotions. Several studies ranging from clinical to molecular, as well as anecdotal evidence, have placed a spotlight on the potential role of the ECS in the pathophysiology of BD. In this perspective, we present advantages and disadvantages of cannabis use in the management of illness course of BD and provide mechanistic insights into how this system might contribute to the pathophysiology of BD.ResultsWe highlight the putative role of selective cannabinoid receptor 2 (CB2) agonists in BD and briefly discuss findings which provide a rationale for targeting the ECS to assuage the symptoms of BD. Further, data encourage basic and clinical studies to determine how cannabis and cannabinoids (CBs) can affect mood and to investigate emerging CB-based options as probable treatment approaches.ConclusionThe probable role of the ECS has been almost neglected in BD; however, from data available which suggest a role of ECS in mood control, it is justified to support conducting comprehensive studies to determine whether ECS manipulation could positively affect BD. Based on the limited available data, we suggest that activation of CB2 may stabilise mood in this disorder.

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“…Similarly, Gerner and Merrill (37) found no significant alteration in CSF levels of PGE in manic patients (n = 6) compared with normals (n = 18), although high levels were found in a few subjects and the sample had a wide variance. Only two published case reports were found which describe manic symptoms associated with NSAID use, for indomethacin (54) and tolmetin (55). Dapsone, a diphenylsulfone that inhibits PGE2 production (56) and release (57), has also been associated with emergence of manic symptoms in three reports (58–60).…”

Section: The Arachidonic Acid Cascade and Bipolar Disordermentioning

confidence: 99%

Evidence for a role of the arachidonic acid cascade in affective disorders: a review

2004

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The treatment of affective disorders continues to present significant clinical challenges, notwithstanding the existence of available mood stabilizers and antidepressants. These difficulties include incomplete response, relapse, and intolerable medication side effects. Fundamental to the therapeutic impasse is incomplete knowledge concerning the neurobiology of mood disorders. Although some relevant biochemical pathways have been identified, including abnormalities of monoamine neurotransmission and of immunological functioning, a fuller understanding is likely to embrace other interrelated pathways. Arachidonic acid (AA) and prostaglandins (PGs) are important second messengers in the central nervous system that participate in signal transduction, inflammation and other vital processes. Their release, turnover, and metabolism represent the 'arachidonic acid cascade'. A significant body of diverse clinical and preclinical research suggests that the AA cascade may be important in affective states. This paper reviews the literature describing the association of affective illness with AA and its metabolites. Possible links between this and other prevailing hypotheses are considered, and implications for further research and for treatment are discussed.

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Mania and Indomethacin

Cited by 6 publications

References 0 publications

Episode-Specific Differential Gene Expression of Peripheral Blood Mononuclear Cells in Rapid Cycling Supports Novel Treatment Approaches

Episode-Specific Differential Gene Expression of Peripheral Blood Mononuclear Cells in Rapid Cycling Supports Novel Treatment Approaches

Bipolar disorder and the endocannabinoid system

Evidence for a role of the arachidonic acid cascade in affective disorders: a review

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