Reply: Valproate Treatment in Schizophrenia: Interaction of GABA with Dopamine?

Winterer, Georg; Schmitt, Ulrich; Schmidt, Lutz

doi:10.1038/sj.npp.1300462

Cited by 1 publication

(1 citation statement)

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“…Wassef and colleagues 123 explore this hypothesis in detail and, in a subsequent article, report on two cases where withdrawal and reinitiation of pharmacologic doses of valproate produced reversible concomitant classic manifestations of dopamine enhancement and reduction in different brain areas-which demonstrates, the authors argue, that GABA may act as a physiologic dopamine regulator. 124 Others have disagreed with this interpretation, 125 howevermaking the point that the precise mechanism of action of valproate as a psychotropic medication has not been definitively elucidated. Additional mechanisms under investigation include neurotropic or neuroprotective effects (which may also be seen with lithium) 126 and the inhibition of histone deacetylase (resulting in the corrected expression of a gene that may be downregulated in schizophrenia).…”

Section: Mechanisms Of Actionmentioning

confidence: 97%

Toward Convergence in the Medication Treatment of Bipolar Disorder and Schizophrenia

Citrome¹,

Goldberg

Stahl

2005

Harvard Review of Psychiatry

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Reaching a correct differential diagnosis among patients with psychotic symptoms was especially important during the era of first-generation antipsychotics, when treatments for the different disorders varied in terms of adverse events and likelihood of response. The historical "overdiagnosis" of schizophrenia and "underdiagnosis" of bipolar disorder in the United States was blamed for an increased exposure to neuroleptics among patients who might have benefited from lithium. With the recognition that second-generation antipsychotics are useful in the treatment of both schizophrenia and bipolar mania, and that combining them with classic mood stabilizers such as valproate may results in increased efficacy, the field is witnessing a convergence of pharmacological approaches to the treatment of schizophrenia and bipolar disorder. Substantially more data is available regarding combination treatments for bipolar disorder than for schizophrenia, and appropriate diagnosis remains important in predicting prognosis, but until the precise pathophysiology of psychotic disorders can be elucidated, and specific targeted treatments crafted, we will continue to see similar blended treatments for these two disease states.

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Section: Mechanisms Of Actionmentioning

confidence: 97%