Is the patient bipolar or not? This question must be one of the most common dilemmas of clinical practice. This month, PL suggests way of trying to approach the question, including the idea that it might not matter at all. It’s suggested that the way we approach it from the DSM structure may set us up for more confusion than we need for an already complex disease.
The special article this month examines different ways of thinking about manic-depressive illness, which isn’t the same thing as bipolar disorder, but rather meant both bipolar illness and what today is diagnosed as “major depressive disorder.”
The classic study of the month examines the ideas of Jules Angst, the great Swiss psychiatric researcher who in the 1960s did research that supported the bipolar/unipolar dichotomy. In the same Zurich cohort, which is one of the best long-term research cohorts in psychiatry, he now has four decades of further evidence that goes against what he had found initially in the 1960s. In short, his research opposes the bipolar/unipolar dichotomy and provides more support for the older notion of manic-depressive illness, or, if one prefers, the concept of a bipolar spectrum that overlaps with the unipolar spectrum.
The drug of the month is lamotrigine. Emphasis is placed on the many ways it is ineffective, so as to better appreciate its important utility as a preventive agent in bipolar illness. The case of the month addresses an example where lamotrigine is not the preferred choice in bipolar illness.
We again invite you to join us for a week-long summer course in Cape Cod this July where we'll be able to interact about many of the topics and approaches discussed in PL.
Nassir Ghaemi MD, Editor
New truths begin as heresies and end as superstitions - T. H. Huxley