It has always been interesting to treat people with bipolar disorder, because of the challenges of their varied presentations and their inherent potential for originality. The advent of lithium and antipsychotics opened the way for making real differences in their lives, but progress was slow in understanding the indications and limitations of treatments. Inspired clinician-researchers such as Jules Angst and Frederick Goodwin paved the way for a systematic approach to elucidating the condition. Charles Bowden's randomised controlled studies of valproate in the 1990s stimulated investment from the pharmaceutical industry that has enabled a firm evidence base to be developed and the introduction of a wide range of agents, particularly new antipsychotics and anticonvulsants with mood-modifying properties.

The challenge now for clinicians is to make sense of the new evidence and find ways to apply it for individual patients. The 2016 Guidelines of the British Association for Psychopharmacology provide a well written and balanced summary from a UK perspective. However, it is also instructive to recognise the perspective from the USA, where clinicians have different priorities and are very alert to new developments. Differences and indeed controversies exist – about the efficacy of antidepressants, for example, and which agents deserve the epithet ‘mood stabiliser’.

The editor and main author of this book, Terence Ketter from Stanford University, is known for his clear understanding of the relevance of clinical trial findings. With experts from specialist areas he presents eight chapters on topics ranging across the life cycle, and across the different phases of the illness. He analyses individual trials for what they tell us about the efficacy and side-effects of a particular drug, and how large a clinical effect it may yield, using number-needed-to-treat analyses and a five-tier hierarchy of evidence.

The chapter on mania endorses the combination of intramuscular haloperidol with lorazepam for severe agitation, in contrast to new National Institute for Health and Care Excellence guidelines (NG10, 2015). Ironically, although valproate does not have Food and Drug Association (FDA) approval for prevention, the combination of an antipsychotic (in the case of risperidone, quetiapine, aripiprazole and ziprasidone) with valproate or lithium does. For prevention in paediatric bipolar disorder the only FDA-approved medicines are lithium and aripiprazole. Amongst lower-tier options discussed are lurasidone and cariprazine, along with ketamine, modafinil, ramelteon and nutraceuticals such as omega-3 fatty acids. There is also a long chapter on pharmacology side-effects and interactions, a subject on which US clinicians are most expert.

This is a very useful book for any prescriber feeling frustrated by their limited ability to control bipolar disorder, whether in the acutely disturbed manic state, the resistant depressive condition, the complex mixed affective state, or in persistently recurrent illness. The book is up to date to 2015 and drugs not yet licensed for the condition are included.