Volume 7, Issue 3, May 2019, Page: 66-70
Introducing the Term “Neuroregulator” in Psychiatry
Michael Raymond Binder, Department of Psychiatry, NorthShore University HealthSystem, Highland Park Hospital, Highland Park, USA
Received: Aug. 13, 2019;       Accepted: Aug. 28, 2019;       Published: Sep. 16, 2019
DOI: 10.11648/j.ajcem.20190703.11      View  631      Downloads  125
Despite the increasing burden of mental illness, social stigma and fears about the potential mind-altering effects of psychotropic drugs prevent most persons from seeking treatment. The problem is compounded by the high rate of diagnostic uncertainty in psychiatry and psychotropic drug labels that can be as confusing as the diagnosis. The terms “anticonvulsant” and “antipsychotic” often have little to do with what is being treated, and the replacement term “mood stabilizer” is inadequate because many patients for whom mood stabilizers are prescribed do not experience any significant mood instability. This calls for a more appropriate label for these psychotropic drugs. Anticonvulsants and antipsychotics have neuroregulatory effects, and converging lines of evidence suggest that most psychiatric disorders are rooted in an inherent hyperexcitability of the neurological system—the neurons won’t shut off. Based on these observations, I propose that the terms anticonvulsant, antipsychotic, and mood stabilizer be replaced with the more pharmacologically and pathophysiologically-related term “NEUROREGULATOR.” The adoption of this descriptive, user-friendly term by prescribing clinicians and dispensing pharmacists would help avoid patient confusion and improve medication compliance by helping patients conceptualize what these drugs do in the brain and how they might be working to relieve symptoms.
Neuromodulators, Neuroregulators, Anticonvulsants, Antiepileptics, Antipsychotics, Mood Stabilizers, Major Tranquilizers, Psychotropic Drugs
To cite this article
Michael Raymond Binder, Introducing the Term “Neuroregulator” in Psychiatry, American Journal of Clinical and Experimental Medicine. Vol. 7, No. 3, 2019, pp. 66-70. doi: 10.11648/j.ajcem.20190703.11
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Binder M. The multi-circuit neuronal hyperexcitability hypothesis of psychiatric disorders. AJCEM. 2019; 7 (1): 12-30.
Yizhar O, Fenno LE, Deisseroth K. Neocortical excitation/inhibition balance in information processing and social dysfunction. Nature. 2011; 477: 171-178.
Jimenez JC, Su K, Goldberg AR, et al. Anxiety cells in a hippocampal-hypothalamic circuit. Neuron. 2018; 97 (3): 670-683.e6.
Friedman AK, Juarez B, [...], Han M-H, et al. KCNQ channel openers reverse depressive symptoms via an active resilience mechanism. Nat Commun. 2016; 7: 11671.
Grunze HCR. The effectiveness of anticonvulsants in psychiatric disorders. Dialogues Clin Neurosci. 2008; 10 (1): 77-89.
Fleming KC, Volcheck MM. Central sensitization syndrome and the initial evaluation of a patient with fibromyalgia: a review. Rambam Maimonides Med J. 2015; 6 (2): e0020.
Blom EH, Serlachius E, Chesney MA, Olsson EMG. Adolescent girls with emotional disorders have a lower end-tidal CO2 and increased respiratory rate compared with healthy controls. Psychophysiology. 2014; 51 (5): 412–418.
Ferreira MAR, O’Donovan MC, [...], and Sklar P. (2008) Collaborative genome-wide association analysis supports a role for ANK3 and CACNA1C in bipolar disorder. Nat Genet. 40 (9): 1056-1058.
Yuan A, Yi Z, Wang Q, et al. ANK3 as a risk gene for schizophrenia: new data in Han Chinese and meta analysis. Am J Med Genet B Neuropsychiatr Genet. 2012; 159B (8): 997-1005.
Lopez AY, Wang X, Xu M, et al. Ankyrin-G isoform imbalance and interneuronopathy link epilepsy and bipolar disorder. Mol Psychiatry. 2017; 22 (10): 1464–1472.
Green EK, Grozeva D, Jones I, et al., Wellcome Trust Case Control Consortium, Holmans PA, Owen MJ, O'Donovan MC, and Craddock N. The bipolar disorder risk allele at CACNA1C also confers risk of recurrent major depression and of schizophrenia. Mol Psychiatry. 2010; 15 (10): 1016-1022.
Liu Y, Blackwood DH, Caesar S, et al. Meta-analysis of genome-wide association data of bipolar disorder and major depressive disorder. Mol Psychiatry. 2011; 16 (1).
Iqbal Z, Vandeweyer G, van der Voet M, et al. Homozygous and heterozygous disruptions of ANK3: at the crossroads of neurodevelopmental and psychiatric disorders. Human Molecular Genetics. 2013; 22: 1960-1970.
Subramanian J, Dye L, and Morozov A. Rap1 signaling prevents L-type calcium channel-dependent neurotransmitter release. Journal of Neuroscience. 2013; 33 (17): 7245.
Santos M, D'Amico D, Spadoni O, et al. Hippocampal hyperexcitability underlies enhanced fear memories in TgNTRK3, a panic disorder mouse model. Journal of Neuroscience. 2013; 33 (38): 15259-15271.
Contractor A, Klyachko VA, and Portera-Cailliau C. Altered neuronal and circuit excitability in fragile X syndrome. Neuron. 2015; 87 (4): 699-715.
O’Brien NL, Way MJ, Kandaswamy R, et al. The functional GRM3 Kozak sequence variant rs148754219 affects the risk of schizophrenia and alcohol dependence as well as bipolar disorder. Psychiatric Genetics 2014; 24: 277–278.
Schizophrenia Working Group of the Psychiatric Genomics Consortium: Ripke S, Neale BM, [...], and O’Donovan MC. Biological insights from 108 schizophrenia-associated genetic loci. Nature. 2014; 511 (7510): 421-427.
Freedman R, Coon H, Myles-Worsley M, et al. Linkage of a neurophysiological deficit in schizophrenia to a chromosome 15 locus. 1997; PNAS. 94 (2): 587–592.
Pizzarelli R and Cherubini E. Alterations of GABAergic signaling in autism spectrum disorders. Neural Plast. 2011; 1011:157193.
Pollack MH, Matthews J, Scott EL. Gabapentin as a potential treatment for anxiety disorders. American Journal of Psychiatry. 1998; 155 (7): 992-993.
Strawn, JR, Geracioti TD Jr. The treatment of generalized anxiety disorder with pregabalin, an atypical anxiolytic. Neuropsychiatr Dis Treat. 2007; 3 (2): 237-243.
Baetz M, Bowen RC. Efficacy of divalproex sodium in patients with panic disorder and mood instability who have not responded to conventional therapy. Can J Psychiatry. 1998; 43 (1): 73-77.
Pande AC, Davidson JR, Jefferson JW, et al. Treatment of social phobia with gabapentin: a placebo controlled study. Clin Psychopharmacol. 1999; 19 (4): 341-348.
Johnstone T, van Reekum CM, Urry HL, Kalin NH, Davidson, RJ. Failure to regulate: counterproductive recruitment of top-down prefrontal-subcortical circuitry in major depression. J. Neuroscience. 2007; 27 (33): 8877-8884.
Leuchter AF, Cook IA, Hunter AM, Cai C, Horvath S. Resting-state quantitative electroencephalography reveals increased neurophysiologic connectivity in depression. PLoS One. 2012; 7 (2): 1-13.e32508.
Bahremand A, Ziai P, Khodadad TK, et al. Agmatine enhances the anticonvulsant effect of lithium chloride on pentylenetetrazole-induced seizures in mice: involvement of L-arginine/nitric oxide pathway. Epilepsy & Behavior. 2010; 18 (3): 186-192.
Brown P, Kashiviswanath S, Huynh A, et al. Lithium therapy in comorbid temporal lobe epilepsy and cycloid psychosis. Oxf Med Case Reports. 2016; 2016 (12): omw089.
Shukla S, Mukherjee S, Decina P. Lithium in the treatment of bipolar disorders associated with epilepsy: an open study. J Clin Psychopharmacol. 1988; 8 (3): 201-204.
Hirschfeld R, Lewis L, Vornik L. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003; 64 (2): 161-174.
Dagani J, Signorini G, Nielssen O, et al. Meta-Analysis of the interval between the onset and management of bipolar disorder. The Canadian Journal of Psychiatry. 2016; 64 (4).
Campbell D. People with bipolar disorder may wait 13 years for diagnosis. The Guardian. https://www.theguardian.com/society/2012/jun/27/bipolar-disorder-diagnosis-survey. (Accessed 10/7/18).
Normann C, Hummel B, Scharer LO, Horn M, Grunze H, Walden J. Lamotrigine as adjunct to paroxetine in acute depression: a placebo-controlled, double-blind study. J Clin Psychiatry. 2002; 63: 337–344.
Barbosa L, Berk M, Vorster M. A double-blind, randomized, placebo-controlled trial of augmentation with lamotrigine or placebo in patients concomitantly treated with fluoxetine for resistant major depressive episodes. J Clin Psychiatry. 2003; 64: 403–407.
Stuppaeck CH, Barnas C, Schwitzer J, Fleischhacker WW. Carbamazepine in the prophylaxis of major depression: a 5-year follow-up. J Clin Psychiatry. 1994; 55: 146–150.
Carpenter WT Jr, Buchanan RW, Kirkpatrick B, Breier AF. Diazepam treatment of early signs of exacerbation in schizophrenia. Am J Psychiatry. 1999; 156 (2) 299-303.
Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: a randomized controlled trial. JAMA Intern Med. 2014; 174 (1): 70-77.
Mason BJ, Heyser CJ. Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence. CNS Neurol Disord Drug Targets. 2010; 9 (1): 23-32.
Shinn AK, Greenfield SF. Topiramate in the treatment of substance related disorders: a critical review of the literature. J Clin Psychiatry. 2010; 71 (5): 634-648.
Leombruni P, Lavagnino L, Fassino S. Treatment of obese patients with binge eating disorder using topiramate: a review. Neuropsychiatr Dis and Treat. 2009; 5: 385-392.
Verrotti A, D’Egidio C, Agostinelli S, Verrotti C, and Pavone P. Diagnosis and management of catamenial seizures: a review. Int J Womens Health. 2012; (4): 535–541.
Papanicolaou J, Summers RJ, Vajda FJE, Louis WJ. The relationship between α2-adrenoceptor selectivity and anticonvulsant effect in a series of clonidine-like drugs. 1982; 241 (2): 393-397.
Hirota T, Schwartz S, Correll CU. Alpha-2 agonists for attention-deficit/hyperactivity disorder in youth: a systematic review and meta-analysis of monotherapy and add-on trials to stimulant therapy. Journal of the American Academy of Child & Adolescent Psychiatry. 2014; 53 (2):153-173.
Weisman H, Qureshi IA, Leckman JF, Scahill L, Bloch, MH. Systematic review: pharmacological treatment of tic disorders – efficacy of antipsychotic and alpha-2 adrenergic agonist agents. Neurosci Biobehav Rev. 2013; 37 (6): 1162-1171.
Ripoll LH. Psychopharmacologic treatment of borderline personality disorder. Dialogues Clin Neurosci. 2013; 15 (2): 213-224.
Olabi B, Hall J. Borderline personality disorder: current drug treatments and future prospects. Ther Adv Chronic Dis. 2010; 1 (2): 59-66.
Ripoll LH, Triebwasser J, Siever LJ. (2011) Evidence-based pharmacotherapy for personality disorders. International Journal of Neuropsychopharmacology. 2010; 14 (9): 1257-1288.
Dib M. Optimizing prophylactic treatment of migraine: subtypes and patient matching. Ther Clin Risk Manag. 2008; 4 (5): 1061-1078.
Boomershine CS. Pregabalin for the management of fibromyalgia syndrome. J Pain Res. 2010; 3: 81-88.
Tremont-Lukats, IW, Megeff C, Backonja MM. Anticonvulsants for neuropathic pain syndromes: mechanisms of action and place in therapy. Drugs. 2000; 60 (5): 1029-1052.
Krystal AD. Antidepressant and antipsychotic drugs. Sleep Med Clin. 2010; 5 (4): 571-589.
Cassidy CM, Balsam PE, Weinstein JJ, et al. A perceptual inference mechanism for hallucinations linked to striatal dopamine. Current Biology. 2018; 28 (4): 503-514.e4.
Freedman R, Coon H, Myles-Worsley M, Orr-Urtreger A, Olincy A, Davis A. Linkage of a neurophysiological deficit in schizophrenia to a chromosome 15 locus. PNAS. 1997; 94 (2): 587-592.
Gittelman JX, Perke DJ, Portfors CV. Dopamine modulates auditory responses in the inferior colliculus in a heterogeneous manner. J Assoc Res Otolaryngol. 2013; 14 (5): 719-729.
Ford JM, Mathalon DH, Kalba S, Whitfield S, Faustman WO, Roth WT. Cortical responsiveness during talking and listening in schizophrenia: an event-related brain potential study. Biological Psychiatry. 2001; 50 (7): 540-549.
Caspi A, Houts RM, [...], Moffitt TE, et al. The p factor: one general psychopathology factor in the structure of psychiatric disorders? Clin Psychol Sci. 2014; 2 (2): 119–137.
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