Razionale farmacologico per l’utilizzazione della quetiapina nel disturbo bipolare
Year: 2006
Type: article
Abstract: Quetiapine, a dibenzothiazepine derivative, is a novel antipsychotic with established efficacy in the treatment of schizophrenia. Quetiapine interacts with multiple neurotransmitter receptors and displays a greater affinity for serotonin 5HT2 than for dopamine D2 receptors. In recent years, quetiapine, as well as other atypical antipsychotics, has emerged both as an alternative and an adjunct to conventional mood stabilisers in the treatment of the different phases of bipolar disorder. The manic phase of the illness is the best studied and the efficacy of most atypical agents is well documented. Evidence for efficacy of newer antipsychotics in the depressive phase is emerging and, at this stage, controlled data are available only for quetiapine and olanzapine. Information on the usefulness of atypical antipsychotics in the maintenance phase of bipolar disorder is still limited. The mechanism of action of quetiapine and other newer antipsychotics in bipolar disorder is only partially known. The antagonistic effect at dopamine D2 receptors is likely to be responsible for the antimanic effect of both conventional and atypical antipsychotics. On the other hand, multiple neurotransmitter mechanisms have been postulated to play a role in the effective treatment of quetiapine and olanzapine in bipolar depression, including diverse targets as serotonin, noradrenaline and dopamine. While neurotransmitter and receptor mechanisms may account for the effects of novel antipsychotics in the acute phases of bipolar disorder, different molecular and structural mechanisms may justify their use in the maintenance phase. In this regard, recent experimental evidence indicates that repeated administration of quetiapine and other novel antipsychotics may modify the expression of proteins that may influence neuronal plasticity, thus exerting a neurotrophic and neuroprotective effect. It can be hypothesized that these long-term adaptive modifications may represent the pharmacological rationale for the use of these agents also in the continuation and maintenance therapy of bipolar disorder. Correspondence: Prof. Edoardo Spina, Sezione di Farmacologia, Dipartimento Clinico Sperimentale di Medicina e Farmacologia, Universita di Messina, Policlinico Universitario, via Consolare Valeria, 98125 Messina, Italy Tel. +39 09
Author: Edoardo Spina
Institution: University of Messina
Language: Italian
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W111142656