Mania: Clinical and Research Perspectives

Dr. Goodnick has assembled an impressive cast of contributors to create an edited text to which he is also a major contributor (co-author of six and solo author of one of the 18 chapters). Published in 1998, the book’s goal was not to re­create Goodwin and Jamison’s comprehensive text Manic Depressive Illness(1) but, rather, to provide an update on cogent clinical and research developments. Lest the title, Mania, be misleading, the book considers all phases of manic depressive (bipolar) disorder and, in doing so, achieves the goal set forth by its editor.

As is inevitable with all referenced books, that dread condition known as “publication lag” partially constricts the book’s timeliness, as exemplified by references no later than 1994 in seven chapters, although five chapters were referenced into 1997. Since it is unlikely that there were no new developments since 1994, the former chapters may have suffered from being the first to be completed and submitted.

The book is divided into three sections—Diagnostic Considerations, Biology, and Treatment. All chapters are well worth reading, but if I had to select a favorite from each section, here are my choices. “Genetics,” by Simpson and De­Paulo, is an outstanding summary of the search for the genetic underpinnings of bipolar disorder complete with explanations of methodology, problems faced by genetic researchers, and the state of research well into 1996. Section 2 contains the obligatory chapters on serotonin, catecholamines, acetylcholine, and γ-aminobutyric acid. It also has a tired chapter on electrophysiology that concludes with the following statement: “It is difficult not to be disappointed by the relatively small yield of results after more than 50 years of EEG research and 25 years of ERP investigation” (p. 185). It also has a superb contribution, “Brain Imaging,” by George, Ketter, Kimbrell, and Post. After a lucid general description of the newer brain imaging technologies, these authors expound on difficulties encountered in studying mania and present the state of the science in this area.

The Treatment section quite appropriately includes chapters on lithium, carbamazepine, and valproate. With regard to lithium, timely updates are presented in a series of study summaries that could have benefited from more critical commentary by the chapter authors. It is somewhat surprising that the section on side effects is not referenced beyond 1993 and suffers from the absence of a succinct discussion of renal lithium issues. My favorite chapter in this section is “Carbamazepine,” by Ketter et al., a comprehensive review of that partially forgotten member of the trio of major mood stabilizers. Everything is here—efficacy data, pharmacology, side effects, and a thorough discussion of drug interactions.

Section 3 concludes with discussions of novel antipsychotics (clozapine, olanzapine, and risperidone), calcium antagonists and newer anticonvulsants, and psychotherapy. Studies of gabapentin, lamotrigine, and, most recently, topiramate in bipolar disorder are products of the late 1990s and, consequently, could not be captured comprehensively in the book. Finally, psychotherapy receives its due as a critical aspect of the comprehensive treatment of people with manic-depressive disorder (although the work of David Miklowitz was not mentioned). This chapter should be required reading, especially for those who dictate the extent of managed care coverage for the treatment of this disorder.

In closing, kudos to Dr. Goodnick and his contributors for a timely and informative update on clinical and research advances in the understanding and treatment of bipolar disorder. In view of the rapid and extensive progress occurring in these areas, I hope that Dr. Goodnick is already hard at work on a second edition.