The discovery of the therapeutic effects of lithium is one of the most fabulous examples of serendipity in all of science. In 1949, John Cade was a 37 year old superintendent of a psychiatric hospital in the Australian outback.
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Dr. Ghaemi, I thought we could discuss this rather controversial issue of whether antidepressants (ADs) should be prescribed in bipolar disorder, particularly in light of the recent article published in the American Journal of Psychiatry by Altshuler et. al. (1).
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First thing's first. What's the deal with all the confusing names for Depakote? The basic, irreducible molecule here is valproic acid, also known as valproate, and the brand name of this is "Depakene", not Depakote.
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Suddenly, it seems that everybody and their cousin is asking us if they have bipolar disorder. A few years ago, bipolar disorder was the ignored orphan diagnosis in psychiatry. However, now that various patented molecules have been proven effective, industry money is flying into efforts to publicize the diagnosis, and it's clearly working.
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It's an amazing metal. Not only does it treat acute mania, prevent recurrences, and treat refractory depression, but when consumed as LiCl, it tastes pretty good on vegetables. Or at least it did before the 1950s, when it was dropped from the list of acceptable salt-substitutes for hypertensives because of a nasty tendency to cause toxicity.
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Dr. Carol Edelstein is a psychiatrist in private practice in Los Angeles, California, and has a particular interest in eating disorders. She describes a case below that falls in that vague hinterland between cyclothymia and bipolar disorder, type II.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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