Bipolar Disorders: Basic Mechanisms and Therapeutic Implications

The last decades of the 20th century witnessed immense progress in the clinical characterization of bipolar disorders, in the evaluation of relevant genetic and environmental factors, in the differential diagnosis from other disorders, in the establishment of prognostic expectations, and in the clinical assessment of effective therapies. Much of this was achieved or influenced by the authors of the 26 chapters in this book.

Progress has not been linear. Many hypotheses are yet to be confirmed. The cyclic nature of bipolar disorder has yet to be incorporated into a useful animal model that would permit proper animal pharmacological research. Candidate genes are still being investigated. Neuroimaging and neurochemical techniques are very gradually yielding the clues about brain functioning that we have so long sought. The effects of adequate treatments on cellular function are still elusive, although the research is increasingly well targeted.

The distinctions between bipolar I and bipolar II and the use of rapid cycling as a course modifier in our diagnostic classifications are increasingly permitting a better selection of patients for therapeutic trials. The use of some anticonvulsants for treatment is leading to more studies of different compounds that may prove to be equally effective.

For the skeptical who believe that the research on basic mechanisms is not relevant to the lives of our patients, the answer may have come from U.S. District Judge Henry H. Kennedy, Jr., in Washington, D.C., who in February 2002 indicated that a patient suffering a bipolar disorder was entitled to the full disability benefits awarded to patients with physical conditions. Judge Kennedy cited statements by physicians indicating that the patient’s disorder was visible on brain scans, was characterized by chemical imbalances in the brain, and might have genetic causes.

Perusal of this well-written book may lead some to believe that we are seeing a dawn in which the nature of bipolar disorders may be elucidated, its course may be predicted, and its treatment interventions may become regularly successful.