NOTES PATHOPHYSIO

Serotonin
Serotonin is a neurotransmitter that is synthesized from the amino acid tryptophan. Decreased levels of
serotonin are commonly found in patients with bipolar disorder and depression. Many antidepressant
medications, including monoamine oxidase inhibitors, selective serotonin reuptake inhibitors and
tricyclic antidepressants reduce the symptoms of depression by increasing the concentration of
serotonin in the brain.
Tryptophan

Glutamate
The amino acid glutamate is the most abundant excitatory neurotransmitter in the brain. A study
published in the December 2007 issue of “Biological Psychiatry” reports that glutamate levels are higher
in certain regions of the brain in patients with bipolar disorder. Many mood-stabilizing drugs used to
treat bipolar disorder are known to decrease the excitatory actions of glutamate.

GABA
Gamma-amino butyric acid, or GABA, is an inhibitory neurotransmitter synthesized from the amino acid
glutamate. GABA modulates the activity of several other neurotransmitters, including dopamine,
serotonin and norepinephrine. An article in the July 2001 issue of “Neuropsychopharmacology” states
that the actions of GABA in the brains of bipolar patients are significantly blunted.

Dopamine
Dopamine is a neurotransmitter synthesized from the amino acid tyrosine. It is known to affect the
reward centers of the brain and also is involved in regulating sleep, motivation, attention and learning. A
review in a 2007 issue of the journal “Acta Psychiatrica Scandinavica Supplementum” concludes that
dopamine plays a role in the cyclical shifts from mania to depression in patients with bipolar disorder.
This review notes that several studies provide evidence that dopamine levels are high during manic
episodes and depression is initiated upon the subsequent down-regulation of dopamine.

Norepinephrine
Norepinephrine is a neurotransmitter that is synthesized from dopamine and is released by neurons in
the brain in response to stress. Patients with bipolar disorder commonly have decreased levels of
norepinephrine in the brain.
The amygdala is an almond-shaped section of nervous tissue located in the temporal (side) lobe of the
brain. ... They are thought to be a part of the limbic system within the brain, which is responsible for
emotions, survival instincts, and memory.

Prefrontal cortex. ... Many authors have indicated an integral link between a person's will to live,
personality, and the functions of the prefrontal cortex. This brain region has been implicated in planning
complex cognitive behavior, personality expression, decision making, and moderating social behavior.
The basal ganglia, also known as basal nuclei, is a region on the underside of the brain that plays a
very important role in muscle coordination and movement.
A manic episode is an emotional state characterized by a period of at least one week where an elevated,
expansive, or unusually irritable mood exists. A person experiencing a manic episode is usually engaged
in significant goal-directed activity beyond their normal activities. People describe a manic mood as
feeling very euphoric, “on top of the world,” and being able to do or accomplish anything.

Norepinephrine is a chemical released from the sympathetic nervous system in response to stress. It is
classified as a neurotransmitter, a chemical that is released from neurons. Because the release of
norepinephrine affects other organs of the body, it is also referred to as a stress hormone.
rning, habit learning, eye movements, cognition, and emotion.

depressive episode in the context of a major depressive disorder is a period characterized by low mood
and other depression symptoms that lasts for 2 weeks or more. When experiencing a depressive
episode, a person can try to make changes to their thoughts and behaviors to help improve their mood.

manic episode is not a disorder in and of itself, but rather is diagnosed as a part of a condition called
bipolar disorder. A manic episode is an emotional state characterized by a period of at least one week
where an elevated, expansive, or unusually irritable mood exists
Biological Differences

Imaging studies have shown that people with bipolar disorder appear to have structural changes in their
brains that may be related to the causes of their disorder. Brain areas such as the amygdala, basal
ganglia, and prefrontal cortex have all been shown to have physical differences in people with bipolar
disorder when compared to those without a mental illness. In addition, people with bipolar disorder also
show abnormal myelination in some areas of the brain. This suggests that damage to the areas of the
brain that regulate emotion may be a cause of bipolar disorder.

Neurotransmitters and Hormones

Bipolar disorder and other mood disorders seem to be associated with an imbalance in brain chemicals
known as neurotransmitters, specifically serotonin, norepinephrine, and dopamine. An imbalance in
hormone levels may also be present in people with bipolar disorder.

Genetics

There is clearly a hereditary component to bipolar disorder, as people with a close blood relative with
bipolar disorder are significantly more likely to develop the disorder themselves. The genetic causes of
bipolar disorder are complex, with more than one gene involved in development of the disorder. Past
research studies have pointed to a handful of genes that seem to play a role in bipolar disorder, and
additional studies are ongoing