Update on the Management of Bipolar Illness [CME]
J Clin Psychiatry 1998;59(9):484-495
© Copyright 2014 Physicians Postgraduate Press, Inc.
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In his opening remarks, Richard C. Shelton, M.D., chairman of the conference, remarked
that he and his colleagues were recently lamenting the difficulty in recruiting subjects
for clinical trials of unipolar and bipolar disorders. One of the factors influencing the
current lack of patients for research studies is that there are fewer untreated or
inadequately-treated individuals with these disorders because of the relative success of
pharmacotherapeutic interventions. On the other hand, he offered, clinicians now see a
larger proportion of treatment-refractory unipolar and bipolar patients; consequently,
clinicians are shifting their thinking toward more complex treatment approaches.
As an educator, Dr. Shelton noted, he is somewhat concerned that the older effective
treatment modalities—such as lithium, tricyclic antidepressants, and monoamine
oxidase inhibitors—are being overlooked in favor of newer pharmacologic agents. Many
psychiatric residents complete their training without ever having used lithium, he said,
and one of the focuses of this conference is the examination of the current position of
lithium as a pharmacologic intervention in the treatment of bipolar illness.