Bipolar disorder is a severe and enduring psychiatric condition which in many cases starts during early adulthood and follows a relapsing and remitting course throughout life. In many patients the disease follows a progressive path with brief periods of inter-episode recovery, sub-threshold symptoms, treatment resistance and increasing functional impairment in the biopsychosocial domains. Knowledge about the neurobiology of bipolar disorder is increasing steadily and evidence from several lines of research implicates immuno-inflammatory mechanisms in the brain and periphery in the etiopathogenesis of this illness and its comorbidities. The main findings are an increase in the levels of proinflammatory cytokines during acute episodes with a decrease in neurotrophic support. Related to these factors are glial cell dysfunction, neuro-endocrine abnormalities and neurotransmitter aberrations which together cause plastic changes in the mood regulating areas of the brain and neuroprogression of the bipolar diathesis. Research in the above mentioned areas is providing an opportunity to discover novel biomarkers for the disease and the field is reaching a point where major breakthroughs can be expected in the not too distant future. It is hoped that with new discoveries fresh avenues will be found to better treat an otherwise recalcitrant disease.
INTRODUCTION
CYTOKINE MARKERS AND PERIPHERAL INFLAMMATION IN BIPOLAR DISORDER
INFLAMMATORY MEDIATORS AND THE CENTRAL NERVOUS SYSTEM
INFLAMMATION AND CHANGES IN NEUROPLASTICITY
NEUROENDOCRINE AND AUTONOMIC DYSREGLATION
NEUROGLIOAL ABNORMALITIES
ASTROGLIA FUNCTION AND GLUTAMATE ABNORMALITIES
ANTI-INFLAMMATORY TREATMENTS-THE INFLAMMATORY PATHWAY
ANTI-INFLAMMATORY POTENTIAL OF LITHIUM AND VALPROATE
RE-PURPOSED DRUGS WITH ANTI-INFLAMMATORY PROPERTIES
DEVELOPMENT OF BIOMARKERS-FOCUS ON CYTOKINES AND BDNF
PERIPHERAL CYTOKINES IN BIPOLAR DISORDER
SERUM BDNF AS A BIOMARKER FOR BIPOLAR DISORDER
COMPARISON OF BIOMARKERS BETWEEN BIPOLAR DISORDER AND MAJOR DEPRESSIVE DISORDER
p11 PROTEIN AND ITS RELATIONSHIP TO MOOD DISORDERS
CONCLUSION
REFERENCES