New Research in Bipolar and Depression – The Glutamate Train

After looking at the future treatment approaches for treatment-resistant depression, I thought I’d share a bit more depression and bipolar research. New options offer hope for everyone who run the gamut of bipolar or depression treatments.

  • A new mood stabilizer
  • A new, novel antidepressant
  • Knowing when depression isn’t depression

Research in Bipolar – A New Mood Stabilizer

If you’ve been making the rounds for bipolar treatment you know that there are only so many anticonvulsants that are used as mood stabilizers. Really just three biggies:

  • Valproate
  • Carbamazepine
  • Lamotrigine
  • Oxcarbazepine (less so)

Occasionally, a few others are thrown in, but really it’s just the above that are shown effective. (This, of course, is in addition to lithium, the actual mood stabilizer. Some antipsychotics may stabilize mood, but that’s a different article.)

But recently a new mood stabilizer has been suggested: memantine.

I had never heard of this drug. It’s a medication used for the treatment of moderate to severe dementia of the Alzheimer’s type.

Memantine works on the glutamatergic system – something I was talking about just last week. It blocks NMDA (N-Methyl-D-aspartic acid or N-Methyl-D-aspartate) receptors so it makes sense that it would act on bipolar depression.

This drug is extremely promising for rapid-cycling bipolar disorder, which is great, because little else is. Keep in mind though, there is little evidence to this effect, but it’s something to watch for. More on the memantine research here.

Research in Depression – A New Antidepressant

Glutamate and Depression and BipolarAnd in continuing on all things glutamate I just happened to come upon a new antidepressant going into phase 2 trials that works on glutamate. This particular antidepressant is designed to treat people with depression with anxiety symptoms. Again, this is good news because depression and anxiety commonly occur together.

This is an interesting drug in that it is an “allosteric modulator” which may elicit a more specific therapeutic use which (I’m inferring) may indicate a smaller side effect profile. ADX71149 is a positive allosteric modulator (PAM) of metabotropic glutamate receptor 2 (mGluR2).

Sorry, I know it’s scientific-y, but that’s what you get when things are in trials.

Recognizing When Depression isn’t Depression

An in an interesting article, Current Psychiatry points out ways of knowing when depression isn’t really depression at all. They identify:

  • Psychological crises that may mimic depression
  • Patients with social challenges that may mimic depression
  • Substance abuse and delirium that may mimic depression

More Psychiatric and Psychological Information

I could share many more interesting psychiatric articles I’ve comes across lately, but that’s it for today. If you’re interested in learning more about psychiatry or psychology, I highly recommend Current Psychiatry and the Psychiatric Times. Neither are particularly easy reading but both are very educational.

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  1. Natasha,

    I am a 60 yr old male and was finally diagnosed with BP Type 2 on the very day of my 55th birthday. In fact, I spent most of the afternoon of my birthday in the ER after suffering a serious emotional breakdown. This was in the 2008-2009 time period and the near collapse of my business due to the U.S. economic meltdown didn’t help matters one bit! On top of that, my marriage was clearly nearing the end of its life cycle. She couldn’t stand much more of my mood swings.

    Fortunately, the ER nurse who first saw me hooked me up with a psychiatrist who could take me within a few days. This was a minor miracle in itself since my birthday falls in mid-December and most docs are on the ski slopes enjoying the holidays.

    I was prescribed one-on-one counseling along with a cocktail of meds that seemed to be the perfect “cure” for my disorder. The main drug was Efexor XR and two other drugs that were prescribed off-label. My mood swings are now 95% under control and people who know me (even those who aren’t aware of my diagnosis) have noticed that I am a much happier person in general. That’s a good thing!

    I must tell you, however, that within a day or two of getting diagnosed I seemed to grieve over the many years (over 40) that I lived unaware that there was something wrong with me. I felt very, very sad about “losing” those years to a disorder that I believed could likely have been treated. Only after mentioning this feeling to my doc did she explain to me that the meds that are available now simply didn’t exist even 5 years ago and not to beat myself up over not getting effective treatment earlier. I can’t tell you how much that advice eased my sense of regret.

    Sadly, my marriage did end. I don’t believe she could cope with the “new” me after nearly 40 years of living with “someone else.” My doc warned me about this, but apparently it was too late to do anything about it. She managed to find her own therapist who told her what she wanted to hear: “Leave and don’t go back for your own good!” If I ever meet this fraud with a license I’m going to give him the beating he deserves (only half-kidding!).

    Once I re-entered the dating world, however, a whole new set of obstacles presented themselves. I experienced some sexual dysfunction that I am convinced are a side-effect of my meds. Not a good thing, but I’m working with my doc to remedy this side-effect. On top of this I kept making the fatal mistake of admitting to my serious girlfriends that I did, in fact, suffer from a “mild case of BP.” BAD MISTAKE! I spoke to my doc about this as well and she gave me some helpful advice on how to get around this ethically without feeling guilty in serious relationships.

    For now, I am at peace with the thought that dealing with my bi-polar disorder will likely never get me to 100% “normalcy” (whatever THAT is!). I am very blessed to have found a doc who seems very attuned to my disorder and has earned my complete trust.

    Finally, I have learned that there is DEFINITELY a stigma associated with most any emotional or “mood” disorder. One can only navigate around this stigma by remaining confident about themselves while also being cautious about who needs to be aware of it. Getting health insurance within 5 years of being diagnosed is virtually impossible if for some reason you have lost your existing plan as my case. My former wife was under a family plan which disappeared following the divorce.

    Fortunately, my health has been excellent since I take very good care of myself. Unfortunately, but I’ve had to scale back on my motorcycle trips until I find coverage in the event of (another) mishap. Being off my bike is for any period of time is enough to drive me crazy all by itself!

    Well, that’s my story and I’m sticking to it. Life is full of ups and downs and I realize that other people are having to deal with much, much worse. So, I feel lucky.

    Thanks for this opportunity share and the best of luck with your blog.

    Sincerely,
    MG Cooper

    P.S. General Practitioners should be barred by their licensing authorities from EVER prescribing meds for suspected BP patients or even those who who exhibit any signs of mood disorder. They simply DO NOT have the expertise or training to diagnose such disorders properly and only seem to dispense such prescription the same way they do any other Rx. That happened to me about 2 years before my eventual diagnosis. There was no follow-up, counseling, or much of anything to see if my Rx (for Celexor) was helping me. I finally weaned myself off of the drug (Geez, what a freakin’ nightmare that was!) since I was not getting any relief for my (undiagnosed) disorder from that drug.

  2. When you talk about glutamine, are you speaking of L-glutamine? I wonder because I have a shit ton of L-glutamine capsules left over from bodybuilding. I don’t know for sure if I’m bipolar. I do know I have tried all the drugs & combos and I’m done with anti fepressants. I took myself off every one og them except Celexa. It helps with my anger.I still have anxiety & physical pain to deal with, I have severely degenerated spinal discs. I am still tapering off narcotics.

    I am getting back to the gym anyway, as lifting has been helpful with anxiety and depression. So I may take L-glutamine as a supplement for keeping muscle. I just wondered if that is the exact form you are talking about. There is a difference beteeen glutaMINE and glutaMATE so I need clarification. Thank you for any info!

  3. Haha… My psychologist and I have some really good conversations because I spend time reading articles off those websites. Im not sure he is use to educated patients.