Update on the Management of Bipolar Illness

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.

J Clin Psychiatry 1998;59(9):484-495