Bipolar Depression

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), there are four categories of bipolar disorder: bipolar I, bipolar II, cyclothymia, and bipolar not-otherwise-specified (NOS) (Ford-Martin, 1999). Bipolar 1 is characterized by a manic phase, which is usually followed by a period of depression. Depression often occurs combined with a manic episode, such as when a patient is depressed, but has racing thoughts. People with bipolar II have major depressive episodes alternating with periods of hypomania, which is milder than the mania of bipolar I patients. These people tend to have low energy, mental retardation and retarded physical processes, and have profound fatigue and hypersomnia, an excessive need for sleep. Patients with cyclothymia have cycling episodes of hypomania

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iewed studies of bipolar and unipolar patients who were on lithium and found that it was more effective than placebo in preventing relapses. There has been a dramatis shift in prescribing patterns in recent years, with valproate now accounting for 70 percent of the mood stabilizer market, and lithium accounting for only 25 percent (Sherman, 2001, Lithium decline). This partly reflects a feeling among clinicians that lithium has become ineffective - it only works in one-third of patients. Since the 1970s, there has been a substantial broadening in the diagnosis of bipolar disorder and this may account for the apparent lack of effectiveness of lithium. Also, more bipolar patients are now taking antidepressants, which can influence their response to mood stabilizers. A review of the international literature actually shows that there was no decline in the efficiency of lithium treatment between 1965 and 1995 (Sherman, 2001, Lithium decline). In fact, recurrence rates have dropped for bipolar patients maintained on lithium during that period. Many of these studies were done in Europe, in clinics where physicians are skilled in the use of lithium, and have found that smaller doses are effective and reduce the negative side ef
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