Bioelectrical modulators and the cell membrane in psychiatric medicine

The term bioelectrical modulators specifically applies to anticonvulsant drugs and mood stabilizers; however, it also embodies the larger more generic concept that bioelectrical modulators can mitigate any pathological condition caused by a dysregulation of the mechanisms that control cellular excitability, especially the excitability of neurons. The beneficial effects of these agents occur primarily as a result of modulatory influences on the bioelectrical properties of the cellular plasma membrane. Channels, transporters, and most other membrane proteins directly or indirectly involved in excitatory or inhibitory synaptic potentials and action potentials are regulated by protein phosphorylation. These proteins are phosphorylated by a class of enzymes termed protein kinases. The overlapping beneficial effects of antipsychotics, antidepressants, anticonvulsants, omega-3 fatty acids, and nonpsychoactive cannabinoids may be because of their common effects at protein kinases, thus affecting the structure and function of the cell membrane and the cell. These changes should help the cell operate within an optimal level of excitation, which may be related to emerging evidence that these therapeutic agents have neuroprotective value. In this review, the latter concepts are discussed clinically as they relate to pain, stroke, schizophrenia, psychoneuroimmunology, Alzheimer's disease, and stress. It is concluded that there is no separation of psychiatry and medicine at the cellular level; there is only psychiatric medicine.