Update on the Management of Bipolar Illness

In his opening remarks, Richard C. Shelton, M.D., chairman of the conference, remarkedthat he and his colleagues were recently lamenting the difficulty in recruiting subjectsfor clinical trials of unipolar and bipolar disorders. One of the factors influencing thecurrent lack of patients for research studies is that there are fewer untreated orinadequately-treated individuals with these disorders because of the relative success ofpharmacotherapeutic interventions. On the other hand, he offered, clinicians now see alarger 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 effectivetreatment modalities—such as lithium, tricyclic antidepressants, and monoamineoxidase inhibitors—are being overlooked in favor of newer pharmacologic agents. Manypsychiatric 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 oflithium as a pharmacologic intervention in the treatment of bipolar illness.