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The inhibition of sodium channels can lead to reduced sodium influx which could, by decreasing glutamate excitatory neurotransmission, modulate manic symptoms. 38 Chapter 3 Carbamazepine, Oxcarbazepine, and Eslicarbazepine Carbamazepine is effective at treating mania and may be effective at preventing manic episodes. Its efficacy in treating or preventing depression is not well established. Carbamazepine has multiple mechanisms of action including modulation of GABA and sodium, calcium, and potassium ion channels, with a particular site of action on the alpha unit of sodium channels.
Atypical antipsychotics may alleviate symptoms of both psychotic and nonpsychotic mania as well as bipolar depression via 5HT2A antagonist properties. Blockade of 5HT2A receptors in the prefrontal cortex can lead to reduced glutamate hyperactivity, leading to decreased activity in the orbital frontal cortex (OFC) and ventromedial prefrontal cortex (VMPFC). 8. Dopamine (DA) hyperactivity could also play a role in the development of psychotic as well as nonpsychotic manic symptoms. Thus, reducing dopamine hyperactivity via D2 blockade by atypical antipsychotics may be an effective antimanic strategy.
Topiramate is approved as an anticonvulsant and for migraines. Topiramate is commonly prescribed as an adjunctive treatment for bipolar disorder. Zonisamide has possible actions on glutamate and GABA, presumably via actions on sodium and calcium channels. Its exact mechanism of action is not known. It has not been well tested in the treatment of bipolar disorder, but it is an approved anticonvulsant. Zonisamide is commonly prescribed for bipolar disorder. Levetiracetam has actions at SV2A proteins on synaptic vesicles, which are hypothesized to affect neurotransmitter release.
From Neurobiology to Treatment: Bipolar Disorder and Schizophrenia Unraveled by Sponsored by: Neuroscience Education Institute, Neuroscience Education Institute