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Bipolar Psychopharmacotherapy: Caring for the Patient.

Sher, Leo MD

The Journal of Nervous and Mental Disease: May 2012 - Volume 200 - Issue 5 - p 454
doi: 10.1097/NMD.0b013e3182532ce2
Book Reviews

Mount Sinai School of Medicine and James J. Peters Veterans’ Administration Medical Center New York, NY

The second edition of Bipolar Psychopharmacotherapy: Caring for the Patient (2011), edited by Hagop S. Akiskal and Mauricio Tohen, is a de facto encyclopedia of psychopharmacological treatment of bipolar disorder. The first edition of this remarkable book was published in 2006. This essential reference book examines pharmacological treatments in the different phases of bipolar disorder and in the diverse demographic groups of patients. The book is edited by leading world experts in the field of bipolar disorders. Hagop S. Akiskal, MD, is Professor of Psychiatry and Director of the International Mood Center at the University of California–San Diego. He is the Editor-in-Chief of the Journal of Affective Disorders. Dr. Akiskal, an outstanding conceptual thinker and the recipient of multiple national and international awards, has performed many pioneering studies in the field of mood disorders. Mauricio Tohen, MD, DrPH, is the Aaron and Bobbie Elliot Krus Endowed Professor of Psychiatry and Head of the Division of Mood and Anxiety Disorders at the University of Texas Health Science Center at San Antonio. He is a leading world expert in clinical epidemiology and clinical trials in the area of bipolar disorders. Dr. Tohen is the recipient of many national and international awards and the current president of the International Society for Bipolar Disorders.

The book is organized into 25 chapters. Chapter 1 provides an overview of diagnostic, public health, and social aspects of bipolar disorder. It is noted that bipolar disorders continue to be poorly understood by both public and physicians. Chapter 2 is dedicated to the discussion of the role of lithium in the pharmacotherapy of bipolar illness, the discovery of the prophylactic action of lithium, practical issues related to the use of lithium in the treatment of bipolar disorder, and possible antisuicidal properties of lithium. Chapters 3, 4, and 5 discuss the history and the theoretical and practical aspects of the use of valproate, lamotrigine, carbamazepine, and other anticonvulsants in the medication management of bipolar illness. Chapters 6, 8, 9, 10, 11, 12, and 13 are devoted to various aspects of the use of atypical antipsychotics in the treatment of bipolar disorder. These chapters describe the proposed mechanisms of action of olanzapine, clozapine, risperidone, paliperidone, quetiapine, ziprasidone, aripiprazole, and asenapine, their clinical indications, the evidence-base supporting their use, and, finally, how they are most effectively and safely used in treating patients with bipolar disorder. Chapter 7 provides an overview of the use of haloperidol and other first-generation antipsychotics in mania. The author notes that haloperidol can still be considered appropriate as the first-line treatment for severe mania especially if rapid tranquilization is required.

Complex combination therapy for long-term stability in bipolar disorder is discussed in Chapter 14. The author stresses the need for careful dose titration for adverse effect avoidance and strongly recommends adding only a single treatment agent at a time. Chapter 15 examines the clinical use of antidepressants in bipolar disorder, which is a subject of controversy. Although many of the core issues regarding the use of tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and bupropion continue to be unresolved, the author points out that there is no a priori reason to exclude antidepressants in the treatment of bipolar disorder. Chapters 16, 17, and 18 are dedicated to the issues related to the treatment of bipolar disorder in different demographic groups: women, pediatric populations, and older persons. A discussion on the pharmacotherapy of bipolar disorder during pregnancy and lactation is very practically important. Chapter 19 explores diagnosis and treatment of mixed states, which usually represent a more complicated course of illness. The issue of rapid cycling of bipolar patients is discussed in Chapter 20.

Chapter 21 describes novel therapeutic approaches for treating bipolar disorder, including studies of substances affecting the endogenous opioid, purinergic, glutamatergic, endocannabinoid, and glucocorticoid systems. These compounds may result in novel treatments for bipolar illness. Chapters 22 and 23 are dedicated to the role of psychoeducation and treatment settings in the management of bipolar disorder. It is noted that the efficacy of psychoeducation in improving treatment adherence has been proven. Chapter 24 explores issues related to the prevention of suicide in bipolar patients. It is pointed out that although suicidal behavior is frequent among all patients with mood disorders, bipolar II patients may be at particularly high risk. Chapter 25 is an overview of principles of caring for bipolar patients. The authors underline that competent pharmacotherapy must be matched with sophisticated psychosocial interventions.

Bipolar Pharmacotherapy: Caring for the Patient is a significant contribution to the clinical literature and would be a useful addition to the bookshelf of clinicians across a range of specialties, including psychiatrists, psychologists, family and primary care physicians, mental health social workers, and other professionals. One can read the book in its entirety and be broadly educated about the complexities of bipolar illness or one can adopt this book as a valuable reference to selectively research different aspects of pharmacological treatment. It is an excellent and timely book.

Leo Sher, MD

Mount Sinai School of Medicine

and James J. Peters Veterans’ Administration

Medical Center

New York, NY

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The author has no conflict of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.