Neurotrophic signaling cascades in the pathophysiology and treatment of bipolar disorder.

Increasing evidence suggests that bipolar disorder (BPD) is associated with regional brain volumetric reductions, accompanied by cellular atrophy and/or loss. Considerable data suggest that the protypical drugs for BPD--lithium and valproate--when administered in therapeutically relevant paradigms regulate neurotrophic signaling cascades. Notably, brain-derived neurotrophic factor, the extracellular signal-regulated kinase pathway, the glycogen synthase kinase-3-mediated pathway and Bcl-2 are major targets for mood stabilizers. Further data suggest that agents which directly target neurotrophic signaling cascades may have considerable utility for the treatment of this devastating illness.