Bipolar Medications

As we approach the end of this century, it is appropriae to consider and celebrate the enormous advances that have been achieved in the reatment of serious brain disorders currently (and misleadingly) termed ‘psychiatric’ or ‘mental.’ The major advances have been pharmacological and of these, litium is perhaps the most important as it demonstrated for the first time the validity of this therapeutic approach. While the psychopharmacological revolution that has taken place since Cade first demonstrated the potential efficacy of lithium in the treatment of bipolor illness has been breathtaking, it is ironic that some 50 years later there is still no clear understanding of how this cation produces its therapeutic effects. Mechanisms of Action of Bipolar Treatments is an excellent volume in part because it covers thoroughly the variety of hypothesis that are still under active consideration. Today most of these are focussed on signal transduction systems, the subject of intense current interest in molecular and cell biology. Indeed, as more of these systems and their components become elucidated, it is safe to assume that some will represent yet additional candidate mediators of lithium’s therapeutic effects. Another attractive feature of this voulme is that it provides a relatively up-to-date overview of more recently discovered agents that can be useful in the treatment of bipolar illness, including carbamazepine, valproate, lamotrigine, and atypical antipsychotic agents. This volume can be recommended strongly to researchers and practicing clinicians alike as it contains important information that is highly relevant to both.—H. Christian Fibiger, Ph.D., Eli Lilly and Company, Indianapolis, Indiana

The book represents an undertaking of massive scholarship covering a truly extraordinary range of scientific research on the basic and some of the clinical pharmacology of agents used or proposed for use in the treatment of bipolar manic-depressive disorders. The book is a monumental achievement. It is especially impressive in that the field of bipolar disorder therapeutics has made relatively little progress at the theoretical level for many years. Now that a number of promising newer alternatives to lithium are emerging, they can be compared to lithium and its very complex neuropharmacology. This comparative approach is promising to shed light on potential common mechanisms of action of this complex class of drugs. Moreover, the application of newer methods of molecular analysis of signaling, second-messenger, and other cytoregulatory systems shows promise of hypothesis that may produce fresh leads to rationally predicted innovations in therapeutics in this important field.—Ross J. Baldessarini, M.D., Professor of Psychiatry (Neuroscience), Harvard Medical School, Belmont, Massachusetts