Book Review
Mood Disorders
Bipolar Disorder: A Clinician’s Guide to Biological Treatments. Lakshmi N Yatham, Vivek Kusumaker, Stanley Kutcher, editors. New York: Brunner-Routledge; 2002. 320 p. US$60.00.
Reviewer
rating*: Excellent
Review by: Rakesh Jain MD, MPH
Lake Jackson, Texas
Shailesh Jain, MD, MPH
Houston, Texas
What an excellent guidebook! We realize it is not typical for a book review to open with such an effusive statement; however, this book certainly deserves this level of praise from all North American clinical psychiatrists.
Currently, bipolar disorder (BD) is the preeminent psychiatric disorder of interest to both practising psychiatrists and the public at large. It is a complex disorder, presenting frequently, perniciously, and confusingly to our offices, with patient stories of misdiagnosis and inappropriate treatment being the rule. We psychiatrists have all wished for a wise, fair, balanced, research-driven, yet clinically useful guide to advise us as we attempt to help our BD patients with pharmacotherapy. Here is the long-awaited, clinician-centred guide to the pharmacotherapy of BD.
The editors of this book are widely respected international authorities on this topic. Additionally, the list of contributors reads like an all-star cast of the best and brightest in the field in Canada and the US.
The book has 12 mostly multiauthored chapters, each of which focuses on important aspects of BD. The first 2 chapters focus on different phases of the illness—hypomania or mania and depression. Successive chapters focus on rapid cycling, maintenance therapy, special population issues, and comorbidities with other Axis I diagnoses. The next 4 chapters focus on separate classes of medications used in the treatment of BD: lithium, atypical neuroleptics, antidepressants, and anticonvulsants. There is also a chapter on somatic treatment for BD. The book ends with a chapter on pharmacologic issues pertaining to the medications, including possible adverse effects and their management.
With so many authors writing separate chapters, there is understandably some overlap in material covered. This, however, is not distracting. The opening chapter on the diagnosis and treatment of hypomania and mania is a tour de force, with an excellent discussion of the clinical pitfalls that face each of us as we assess patients with mood disorders. The authors have clearly kept practising clinician readers in mind: they have broken the chapter into sections that closely follow how clinicians assess and treat these patients. There is a wonderfully thought-out section on rationale in designing treatment strategies and an equally useful and practical treatment algorithm section.
The second chapter, on bipolar depression, does not offer as many pearls of wisdom, but this is because our understanding of the treatment of bipolar depression is less well studied. Experts, particularly those from Europe, have differing views on this subject. Nevertheless, we enjoyed reading this chapter. We would have liked to see a flow sheet illustrating how the authors manage bipolar depression in their clinics, so that we could see how expert pychopharmacologists handle the most vexing phase of this illness, the depressed phase.
We similarly appreciate that the editors have devoted an entire chapter to the plight of rapid cyclers. This chapter has both a research and clinically driven, evenhanded approach to this complex clinical presentation. Similarly, the chapter on maintenance issues, while highly research-data driven, is very informative to practising clinicians. The data supporting lithium use for maintenance are fully researched and elegantly presented.
The next several chapters highlight each of the following individually: lithium, antidepressants, anticonvulsants, and somatic treatments. The data for these treatments are extensive, and we commend the various authors for discussing both supportive and nonsupportive data, for allowing us to examine the data for ourselves, and for then offering their own thoughts and recommendations. Well done!
The final chapter is devoted to pharmacodynamic and pharmacokinetic issues, along with side effect management. Side effects of these medications are one of the most important reasons for poor compliance, and we would have liked a significantly expanded discussion of side effect management from these experts. “How do they manage these side-effects in the real world?” is a question we frequently asked ourselves as we read this chapter. A listing of side effects alone does not adequately answer these questions satisfactorily.
To keep up with the burgeoning database in BD research, we hope these talented editors consider a second edition within the next 2 years. We have minor suggestions to offer to make this an even more useful book. Consider more frequent use of tables and flow charts and consider ending the book with a single-authored chapter summarizing the practical information gathered from reading the previous chapters. Further, assessing and managing BD in children and adolescents is an emerging psychiatric quandary, and clinicians would benefit from its discussion in the next edition.
As we read this book, we could not help but be impressed by how far the biological treatment of BD has evolved over the last few decades. This progress in our knowledge base can only benefit more of our patients. There is indeed a great deal to like about this book, which has a place of honour on both our bookshelves. We strongly recommend it to our fellow clinical psychiatrists.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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