Comparative pharmacology of bipolar disorder and schizophrenia.

The treatment of acute mania and schizophrenia overlap considerably in terms of the typical and atypical neuroleptics, but begin to diverge with the recognized mood stabilizers for bipolar affective illness--lithium, carbamazepine, and valproate--which are substantially less effective in schizophrenia than in affective illness. Moreover, the L-type calcium channel blocker verapamil is reported to be effective in mania, but it may exacerbate schizophrenia. A series of new putative mood stabilizing anticonvulsants (such as lamotrigine, gabapentin, and topiramate) and possible second-messenger targeted treatments (tamoxifen and omega-3 fatty acids) deserve further study in both affective and schizophrenic syndromes. Repeated transcranial magnetic stimulation (rTMS) of the brain offers considerable promise in the treatment of a variety of neuropsychiatric syndromes, especially with preliminary evidence of frequency-dependent effects on regional cerebral blood flow. New insights about the potential neurotrophic effects of lithium and the gene transcriptional effects of other psychotropics offer exciting new targets for therapeutics and strategies for future clinical trials and therapeutic applications in both syndromes.