Robert M Post1, Peter Kalivas. 1. MD, Head, Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA. robert.post@speakeasy.net
Abstract
BACKGROUND: Bipolar disorder has a high co-occurrence with substance use disorders, but the pathophysiological mechanisms have not been adequately explored. AIMS: To review the role of stress in the onset and recurrence of affective episodes and substance misuse. METHOD: We review the mechanisms involved in sensitisation (increased responsivity) to recurrence of stressors, mood episodes and cocaine use. RESULTS: Evidence suggests that intermittent stressors, mood episodes and bouts of cocaine use not only show sensitisation to themselves, but cross-sensitisation to the others contributing to illness progression. Converseley, an understanding of the common mechanisms of sensitisation (such as regionally selective alterations in brain derived neurotrophic factor (BDNF) and hyperactivity of striatally based habit memories), could also result in single therapies (such as N-acetylcysteine) having positive effects in all three domains. CONCLUSIONS: These interacting sensitisation processes suggest the importance of early intervention in attempting to prevent increasingly severe manifestations of bipolar illness and substance misuse progression.
BACKGROUND:Bipolar disorder has a high co-occurrence with substance use disorders, but the pathophysiological mechanisms have not been adequately explored. AIMS: To review the role of stress in the onset and recurrence of affective episodes and substance misuse. METHOD: We review the mechanisms involved in sensitisation (increased responsivity) to recurrence of stressors, mood episodes and cocaine use. RESULTS: Evidence suggests that intermittent stressors, mood episodes and bouts of cocaine use not only show sensitisation to themselves, but cross-sensitisation to the others contributing to illness progression. Converseley, an understanding of the common mechanisms of sensitisation (such as regionally selective alterations in brain derived neurotrophic factor (BDNF) and hyperactivity of striatally based habit memories), could also result in single therapies (such as N-acetylcysteine) having positive effects in all three domains. CONCLUSIONS: These interacting sensitisation processes suggest the importance of early intervention in attempting to prevent increasingly severe manifestations of bipolar illness and substance misuse progression.
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Authors: Robert M Post; Gabriele S Leverich; Lori L Altshuler; Mark A Frye; Trisha Suppes; Paul E Keck; Susan L McElroy; Willem A Nolen; Ralph Kupka; Heinz Grunze; Joerg Walden; Mike Rowe Journal: Int Clin Psychopharmacol Date: 2011-03 Impact factor: 1.659
Authors: Patrick O McGowan; Aya Sasaki; Ana C D'Alessio; Sergiy Dymov; Benoit Labonté; Moshe Szyf; Gustavo Turecki; Michael J Meaney Journal: Nat Neurosci Date: 2009-03 Impact factor: 24.884
Authors: Robert M Post; Lori L Altshuler; Gabriele S Leverich; Willem A Nolen; Ralph Kupka; Heinz Grunze; Mark A Frye; Trisha Suppes; Susan L McElroy; Paul E Keck; Mike Rowe Journal: Prim Care Companion CNS Disord Date: 2014-12-18