The British Journal of Psychiatry (2002) 181: 360
© 2002 The Royal College of Psychiatrists
Bipolar Disorders: Basic Mechanisms and Therapeutic Implications
Nicol Ferrier, Head of Department
Department of Psychiatry, University of Newcastle upon Tyne, Royal
Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
EDITED BY SIDNEY CROWN and ALAN LEE
Edited by J.C. Soares & S. Gershon. New York: Marcel Dekker. 2000. 580
pp. £39.95 (hb). ISBN 0 8247 0360 X
Now is an exciting time for research in bipolar disorder and this book
captures the mood of the moment. It summarises neurobiological and
psychopharmacological research into bipolar disorder at the end of the 20th
century. Although there have been a number of other books on recent advances
in bipolar disorder, most of these have concentrated on clinical features and
response to treatment, and it is very useful to have a relatively up-to-date
review of research on basic mechanisms and their therapeutic implications.
As is outlined in the foreword and in a useful summary chapter by Neumaier
& Dunner (the latter described the concept of rapid cycling), bipolar
disorder was one of the first areas of biological psychiatry research with
funding and central support in the 1960s fuelled largely by the increasing use
of lithium. However, research in unipolar depression and schizophrenia rapidly
overtook bipolar disorder as the priority and it is only in the past 5-10
years that research has been regenerated in bipolar disease. There have been a
number of triggers for this increasing interest, including the realisation
that lithium has many flaws and drawbacks and that the socalled Kraepelinian
dichotomy and classical bipolar illness are simplistic and misleading
concepts. The catalyst for this increase in research has been the Stanley
Foundation in the USA, whose munificence has fuelled much good work and the
development of centres with a sufficient critical mass of researchers. There
are some new and exciting leads, which are described in detail in this volume.
Examples include the molecular and cellular mechanisms of lithium's action,
structural and neuropathological abnormalities and the delineation of
psychological changes. The number of topics and range of neurobiological
research documented here are extensive and it is clear that not all of the
abnormalities reported in this text are substantial. Many will prove to be
evanescent and/or epiphenomena. However, it is timely to have this review and
those researching into bipolar disorders would be well advised to have access
to this book. It also includes some interesting reviews of topics not often
looked at in detail such as secondary mania and biological factors relating to
bipolar disorders in children, adolescents and late life.
Soares and Gershon should be congratulated on bringing together key opinion
leaders in this field, albeit with a North American perspective. There is
little overlap in the chapters, which shows firm editorial control.
