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Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and cross-sensitisation

  • Robert M. Post (a1) and Peter Kalivas (a2)
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.

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Copyright
Corresponding author
Robert M. Post, MD, Head, Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA. Email: robert.post@speakeasy.net
Footnotes
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Declaration of interest

R.M.P. is a speaker for AstraZeneca and Validus, and has consulted with Puretech, Sunovion and Teva within the past 12 months.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and cross-sensitisation

  • Robert M. Post (a1) and Peter Kalivas (a2)
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