The possible involvement of NMDA glutamate receptor in the etiopathogenesis of bipolar disorder.

Glutamate is the most abundant excitatory neurotransmitter in the brain and the ionotropic NMDA receptor is one of the major classes of its receptors, thought to play an important role in schizophrenia and mood disorders. The current systematic review summarized the evidence concerning the involvement of NMDA receptors in the pathophysiology of bipolar disorder. Genetic studies point to the genes encoding the NMDA 1, 2A and 2B subunits while neuropathological studies suggest a possible region specific decrease in the density of NMDA receptor and more consistently a reduced NMDA-mediated glutamatergic activity in patients with bipolar disorder in the frame of slower NMDA kinetics because of lower contribution of NR2A subunits. However the literature is poor and incomplete; future research is necessary to elucidate the mechanisms underlying bipolar disorder and its specific relationship to a possible NMDA malfunction and to explore the possibility of developing novel therapeutic agents.