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Serotonergic dysregulation in bipolar disorders: a literature review of serotonergic challenge studies
Author(s) -
Sobczak S,
Honig A,
Van Duinen MA,
Riedel WJ
Publication year - 2002
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1034/j.1399-5618.2002.01217.x
Subject(s) - serotonergic , bipolar disorder , mania , psychology , clomipramine , serotonin , citalopram , medicine , psychiatry , mood , anxiety , antidepressant , receptor
Objectives: Serotonin (5‐hydroxytryptamine; 5‐HT) and endocrine abnormalities have been repeatedly reported in bipolar disorders (BD). Useful methods to investigate 5‐HT responsivity, and the interaction with neuroendocrine functioning, are provided by acute 5‐HT challenge and depletion paradigms. In this review 5‐HT challenges are limited to paradigms that stimulate 5‐HT activity in BD. Methods: Literature was searched for in electronic libraries: MEDLINE and PSYCHLIT, period 1966–2001. Papers describing effects of an acute 5‐HT challenge on neuroendocrine functioning in BD patients were selected. Results: Review of the literature revealed 15 studies: five papers described the effects of 5‐HT challenges in manic BD patients, four papers in euthymic BD and seven in depressed BD patients. The reviewed 5‐HT challenge paradigms are acute administration of oral and intravenous (i.v.) dosage of d,l‐fenfluramine, tryptophan, 5‐hydroxytryptophan, ipsapirone and buspirone. There were no papers which investigated neuroendocrine effects of m‐chlorophenylpiperazine, clomipramine and citalopram in BD patients and were therefore not reviewed. Conclusions: The literature on 5‐HT challenge procedures in BD shows evidence for a blunted prolactin (PRL) in mania and depression as well as a blunted cortisol in euthymic BD patients. This suggests that in both mania and depression similar changes in the 5‐HT system are involved. It is speculated that blunting of cortisol responses in euthymic BD patients may be a result of chronically altered 5‐HT functioning, whereas changes in PRL release following 5‐HT challenges reflect more state‐dependent changes in 5‐HT activity. The 5‐HT responsivity in BD patients has also been associated with pharmacological treatment, suicidal behaviour, weight loss and age. Recommendations for future research are given.