Bortolato B, Berk M, Maes M, McIntyre R S, Carvalho A F
Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Rua Prof. Costa Mendes 1608, 4o andar, 60430-040, Fortaleza, CE, Brazil.
Curr Mol Med. 2016;16(2):119-36. doi: 10.2174/1566524016666160126144027.
Fibromyalgia (FM) is a prevalent disorder defined by the presence of chronic widespread pain in association with fatigue, sleep disturbances and cognitive dysfunction. Recent studies indicate that bipolar spectrum disorders frequently co-occur in individuals with FM. Furthermore, shared pathophysiological mechanisms anticipate remarkable phenomenological similarities between FM and BD. A comprehensive search of the English literature was carried out in the Pubmed/MEDLINE database through May 10th, 2015 to identify unique references pertaining to the epidemiology and shared pathophysiology between FM and bipolar disorder (BD). Overlapping neural circuits may underpin parallel clinical manifestations of both disorders. Fibromyalgia and BD are both characterized by functional abnormalities in the hypothalamic-pituitary-adrenal axis, higher levels of inflammatory mediators, oxidative and nitrosative stress as well as mitochondrial dysfunction. An over-activation of the kynurenine pathway in both illnesses drives tryptophan away from the production of serotonin and melatonin, leading to affective symptoms, circadian rhythm disturbances and abnormalities in pain processing. In addition, both disorders are associated with impaired neuroplasticity (e.g., altered brain-derived neurotrophic factor signaling). The recognition of the symptomatic and pathophysiological overlapping between FM and bipolar spectrum disorders has relevant etiological, clinical and therapeutic implications that deserve future research consideration.
纤维肌痛（FM）是一种常见疾病，其定义为存在慢性广泛性疼痛，并伴有疲劳、睡眠障碍和认知功能障碍。最近的研究表明，双相谱系障碍在纤维肌痛患者中经常同时出现。此外，共同的病理生理机制预示着纤维肌痛和双相情感障碍（BD）之间存在显著的现象学相似性。通过在Pubmed/MEDLINE数据库中对截至2015年5月10日的英文文献进行全面检索，以确定与纤维肌痛和双相情感障碍（BD）之间的流行病学及共同病理生理学相关的独特参考文献。重叠的神经回路可能是这两种疾病平行临床表现的基础。纤维肌痛和双相情感障碍均以下丘脑-垂体-肾上腺轴功能异常、炎症介质水平升高、氧化和亚硝化应激以及线粒体功能障碍为特征。两种疾病中犬尿氨酸途径的过度激活使色氨酸无法用于合成血清素和褪黑素，从而导致情感症状、昼夜节律紊乱和疼痛处理异常。此外，这两种疾病都与神经可塑性受损有关（例如，脑源性神经营养因子信号改变）。认识到纤维肌痛和双相谱系障碍之间在症状和病理生理学上的重叠具有相关的病因学、临床和治疗意义，值得未来研究关注。
