Akiskal HS.
Temperament in Bipolar Mixed States: Characterizing the Complex Clinical Interface Between Mania, Hypomania, and Depression.  
American Psychiatric Association Annual Meeting, 1999
Report on Symposium: "I will summarize a paper I presented on the complex diagnostic challenges of bipolar mixed states."

You can see the entire article but must register with Medscape first.  If you are registered, go directly to the article.  If you are not registered, go here to do so and then close that window to return for the link.

 

Akiskal HS. 
Complex Bipolarity: Focus on Temperament and Mixed States.  
American Psychiatric Association 153rd Annual Meeting, Chicago 2000.  
Symposium Summary (Medscape): [This is the "leading edge" of theory about what mixed states really are; perhaps hard to follow if you're not really into this discussion, but if you can figure it out, this is for the moment the ultimate authority on how "manic" and "depressive" states can mix together -- obviously a crucial issue in this illness. Here's my "translation" into non-jargon, but then you'll have to trust me; read his if you can.

Sorry, the original article was once available on Medscape, but no longer (revised July 2003).  

Akiskal HS, Pinto O 
The evolving bipolar spectrum. Prototypes I, II, III, and IV. 
Psychiatr Clin North Am 1999 Sep;22(3):517-34, vii
Abstract: "broadening the bipolar spectrum"

Allison DB et al 
Antipsychotic-Induced Weight Gain: A Comprehensive Research Synthesis 
Am J Psychiatry 1999 156: 1686-1696.
Abstract: "Among newer antipsychotic agents, mean increases were as follows: clozapine, 4.45 kg; olanzapine, 4.15 kg..."

Altshuler et al. 
Antidepressant-induced mania and cycle acceleration: a controversy revisited. 
Am J Psychiatry 1995 Aug;152(8):1130-8
Abstract: "Mania is likely to be antidepressant-induced and not attributable to the expected course of illness in one-third of treatment-refractory bipolar patients, and rapid cycling is induced in one-fourth... Antidepressant-induced cycle acceleration (but not antidepressant-induced mania) is associated with younger age at first treatment and may be more likely to occur in women and in bipolar II patients."

Angst J 
The emerging epidemiology of hypomania and bipolar II disorder 
J Affect Disord 1998 Sep;50(2-3):143-51
Abstract: "The Zurich cohort study identified a prevalence rate up to age 35 of 5.5% of DSM-IV hypomania/mania and a further 2.8% for brief hypomania (recurrent and lasting 1-3 days)... The study suggests that recurrent brief hypomania belongs to the bipolar spectrum."

Arborelius L, Owens MJ, Plotsky PM, Nemeroff CB 
The role of corticotropin-releasing factor in depression and anxiety disorders. 
J Endocrinol 1999 Jan;160(1):1-12
Abstract: [a review of stress hormone effects from the principal research team in this area]. "Corticotropin-releasing factor (CRF), a 41 amino acid-containing peptide, appears to mediate not only the endocrine but also the autonomic and behavioral responses to stress."

Asconape JJ et al.  Valproate-associated pancreatitis.  Epilepsia 1993 Jan-Feb;34(1):177-83. 
Abstract: [If you'd like to see the numbers, most of what you'd want is in the abstract.]

Ayd F, Jr., Palma JM "Suicide: Risk Recognition and Prevention" 
Psychiatric Times May 1999 Vol. XVI Issue 5
Review (full text): a very thorough, thus more lengthy, review of suicidal risk and how to approach it. Excellent overview.
Web Site Link

Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR
Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months.
Psychosom Med 2000 Sep-Oct;62(5):633-8
Abstract: [this is worth reading] "After 10 months, however, remitted subjects in the exercise group had significantly lower relapse rates (p = .01) than subjects in the medication group. Exercising on one's own during the follow-up period was associated with a reduced probability of depression diagnosis at the end of that period (odds ratio = 0.49, p = .0009)."

Barlow DH, Gorman JM, Shear MK, Woods SW
Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial.
JAMA 2000 May 17;283(19):2529-36
Abstract:  Six months after treatment was stopped (medications and/or CBT), CBT was superior to meds, and even to CBT plus meds.   

Benazzi F 
Prevalence of bipolar II disorder in outpatient depression: a 203-case study in private practice
J Affect Disord 1997 Apr;43(2):163-6
Abstract: [200 patients, standard diagnostic instrument, but an author with a clear interest in bipolar II; compare Manning, a family practice doc', who might have less diagnostic bias (though still some).]  

Bipolar Network News.  
Published by the Stanley Foundation, edited by Dr. Post and Gail Leverich from NIMH; very, very up to date.  Free if you request it from their 800 number, on the Stanley Foundation site.   

Biweekly review (requires PDF reader): "If most of the country scores an F, Oregonians only managed to score a D". Corvallis Gazette Times, AP article, 11/14/1999.

Bowden CL 
Efficacy of divalproex vs lithium and placebo in the treatment of mania. The Depakote Mania Study Group.
 JAMA 1994 Mar 23-30;271(12):918-24
Abstract: [The original demonstration of valproate’s effectiveness in bipolar disorder; subsequent analysis of this data showed a slight edge for valproate over lithium in the treatment of mixed states and rapid cycling].

Bremner JD, Narayan M, Anderson ER, Staib LH, Miller HL, Charney DS
Hippocampal volume reduction in major depression
Am J Psychiatry 2000 Jan;157(1):115-8
Abstract: [Authors conclude that] "findings are consistent with smaller left hippocampal volume in depression."  

Brown ES, Suppes T 
Mood symptoms during corticosteroid therapy: a review. 
Harv Rev Psychiatry 1998 Jan-Feb;5(5):239-46
Abstract: "The limited data available suggest that symptoms of hypomania, mania, depression, and psychosis are common during therapy."

Bryden KE, Kopala LC 
Body mass index increase of 58% associated with olanzapine. 
Am J Psychiatry 1999 Nov;156(11):1835-6. (letter)

Burns DD 
Feeling Good, The New Mood Therapy (reissued 1999) 
Wholecare; ISBN: 0380810336 1999
Reviewer: A reader from Boston October 26, 1999
The list of the ten "cognitive distortions" on pages 40-41 is worth the price of this book. I have memorized them and use them almost every day to catch myself making mistakes in my thinking when I'm angry or disappointed, or sad, or peeved, or whatever. Memorize that list. It's not hard to do. And then when you catch yourself making one of those mistakes, you instantly feel better, because the "cognitive distortion" warped your view of the world in a way that made you have more negative emotion than you needed to have. This is different than positive thinking. It's different than trying to make yourself believe something positive you don't believe. This is clearing up the illusions you have that make you feel bad. It is practical and is very effective.
Amazon book link

Calabrese JR, Bowden CL, Sachs GS, Ascher JA, Monaghan E, Rudd GD 
A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. 
J Clin Psychiatry 1999 Feb;60(2):79-88
Abstract: "The proportions of patients exhibiting a response on CGI-I were 51%, 41%, and 26% for lamotrigine 200 mg/day, lamotrigine 50 mg/day, and placebo groups, respectively. Adverse events and other safety results were similar across treatment groups..."

Carol 
The Mercurial Mind: Living with bipolar disorder.
Website: [Go to "phases" to see clear descriptions of bipolar depression, hypomania, and mixed states. Her section on suicide, which you can access from "mixed states and suicidal impulses", includes good resources for people with thoughts about suicide. Her "Links Suggested by Visitors", at the bottom of the suicide page, has some excellent links, including resources for parents of bipolar kids.]

Cardno AG et al  
Heritability estimates for psychotic disorders: the Maudsley twin psychosis series. 
Arch Gen Psychiatry 1999 Feb;56(2):162-8
Abstract: "Heritability estimates for...schizoaffective disorder, mania, [and] schizophrenia were all between 82% and 85%."

Carro E, Nunez A, Busiguina S, Torres-Aleman I. 
Circulating insulin-like growth factor I mediates effects of exercise on the brain. 
J Neurosci 2000 Apr 15;20(8):2926-33.
Abstract

CD Summary: Center for Disease Prevention and Epidemiology, Oregon Health Division. Exercise: Live Long and Prosper. July 22 Vol. 46, No. 15
Web Site Link

Chappell KA, Markowitz JS, Jackson CW 
Is valproate pharmacotherapy associated with polycystic ovaries? 
Ann Pharmacother 1999 Nov;33(11):1211-6
Abstract (review): "...there appears to be a greater incidence of polycystic ovaries associated with valproate use in comparison with other anticonvulsants. The mechanism by which valproate may induce polycystic ovarian syndrome is unknown, but could possibly be secondary to valproate-induced weight gain..."

Davis AT, Schrueder C 
The prediction of suicide. 
Med J Aust 1990 Nov 5;153(9):552-4
Abstract: "successful assessment of the risk of suicide and intervention to prevent it depend on gaining an understanding of the individual patient and developing a therapeutic relationship."

Diagnostic and Statistical Manual of Mental Disorders : DSM-IV (4th Ed) (June 1994) American Psychiatric Press; ISBN: 0890420629

Dixon JF, Hokin LE 
Lithium acutely inhibits and chronically up-regulates and stabilizes glutamate uptake by presynaptic nerve endings in mouse cerebral cortex. 
Proc Natl Acad Sci U S A 1998 Jul 7;95(14):8363-8
Abstract: [lithium shown to decrease glutamate reuptake, or increase it, depending on time frame, and narrows the range of reuptake shown in treated versus control mice].

Duman RS, Malberg J, Thome J  
Neural plasticity to stress and antidepressant treatment. 
Biol Psychiatry 1999 Nov 1;46(9):1181-91
Abstract: [A recent review of extensive work by Duman and others on "brain-derived neurotrophic factor" (BDNF) and other evidence of the role of trophic factors and stress in depression and its treatment].

Duman RS, Nestler EJ   
Role of Gene Expression in Stress and Drug-Induced Neural Plasticity   
TEN [The Economics of Neuroscience] . 2000;2(4):53-70
Full text: this is a great opportunity to access online the full story as told by Dr. Duman; it summarizes work he and Dr. Nestler have produced over several years in many separate publications. If this topic grabs you and you’re not afraid of some moderately technical science – e.g. you clinicians! – READ THIS.

Duman RS, Heninger GR, Nestler EJ. 
A molecular and cellular theory of depression. 
Arch Gen Psychiatry. 1997;54:597-606.
Abstract

Duman RS, Vaidya VA  
Molecular and cellular actions of chronic electroconvulsive seizures.  
J ECT 1998 Sep;14(3):181-93.  
Abstract: "This work has led to the hypothesis that electroconvulsive shock and antidepressant drugs, via regulation of neurotrophic factors, reverse the atrophy of stress-vulnerable neurons or protect these neurons from further damage."

Erfurth A, et al.  
An open label study of gabapentin in the treatment of acute mania. 
J Psychiatr Res 1998 Sep-Oct;32(5):261-4
Abstract : The authors present their experience with a series of 14 patients, followed 21 days.   

Fawcett J Bipolar Disorder: On the Edge of DSM-IV. 
American Psychiatric Association meeting, May 18 - 21, 1997
Report on Symposium (full text of report):: "One way to minimize missing treatable bipolar disorders, is to know when to suspect bipolar ‘spectrum’ illnesses. For example, recurring patterns: including recurrent affective episodes, recurrent psychoses, recurrent irritability - or really any recurrent affective patterns, should alert one to the possibility of a bipolar spectrum illness."
Web Site Link; register here first if you are not already registered with Medscape, then close that window to return here for the link.. 

Fawcett J(b) cited in Goldman E 
"Severe Anxiety, Agitation are Warning Signals of Suicide in Bipolar Patients". 
(based on a presentation at the Western Psychiatric Institute and Clinic). 
Clinical Psychiatry News Sept. 1999, pg 25.
Review of Symposium [no link available]: "I am very aggressive in treating anxiety in depressed patients. I will go to any length to suppress it." said Dr. Fawcett, [whose] therapeutic boldness is based on his observations of hundreds of cases of suicidality; acute anxiety and agitation are consistent features in these patients’ psychic landscape.

Feighner JP 
Overview of antidepressants currently used to treat anxiety disorders. 
J Clin Psychiatry 1999; 60 (suppl 22).
Review: "TCA’s appear to be at least equivalent to the benzodiazepines in the short term, and more effective in the long term...". [See Table 1: SSRI’s and TCA’s are rated equal in efficacy in GAD relative to Effexor.  Effexor is the only one for which FDA approval has been sought, not the only one that works.]

Fisher R and Ury W 
Getting to Yes : Negotiating Agreement Without Giving in
Penguin USA (Paper); ISBN: 0140157352
Amazon book link

Frances A, Docherty JP, Kahn DA, eds. 
The Expert Consensus Guideline Series: Treatment of Bipolar Disorder. 
J Clin Psychiatry 1996;57 (suppl 12A).
A "guide for patients and families". These guidelines do not address bipolar II separately, but are an excellent 8 page overview for Bipolar I.   The Bipolar 2000 guidelines have been released now as well, focusing on medication options.
Web Site Link

Frank E. 
Examining Prophylactic Effects of Interpersonal and Social Rhythm Therapy
[Interview with Dr. Ellen Frank, the one of the developers of this technique: history, approach, preliminary results.]
Web Site Link

Frank E and Thase ME. 
Natural history and preventative treatment of recurrent mood disorders. 
Annu Rev Med 1999;50:453-68.
Abstract (review chapter): "In the area of treatment, the life-long nature of many of the mood disorders is described, as is the consequent role of the primary care physician in their management. The evidence for the efficacy of the depression-specific psychotherapies, cognitive therapy and interpersonal therapy, is reviewed."
Abstract

Freeman MP, McElroy SL. 
Clinical picture and etiologic models of mixed states. 
Psychiatr Clin North Am 1999 Sep;22(3):535-46, vii
Abstract: "Although conceptualized as polar opposites, manic and depressive symptoms often co-occur in bipolar disorder."

Frye M.  
Presented at the Third International conference on bipolar disorder, June 1999.  
See reference in Bipolar Network News, vol. 6, issue1.  

Frye MA et al. 
Data presented at the 1998 Annual Meeting of the American Psychiatric Association, Toronto, Ontario, Canada.

Frye MA et al. 
The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study. 
 J Clin Psychiatry 2000 Jan;61(1):9-15 
Abstract:  The authors see patients requiring more medications now than 10 or 20 years ago, seemingly due to an increasing severity of illness.  Nearly half of patients leaving NIMH's treatment program are taking 3 or more medications.         

Gabbard G.  
Borderline Personality Disorder.  
Presented at the U.S. Women's Healthcare Congress, San Diego, 8/2000.  
[Here's an example of his work, a good review, that speaks indirectly to this issue: Abstract.]

Geller B, Fox LW, Clark KA 
Rate and predictors of prepubertal bipolarity during follow-up of 6- to 12-year-old depressed children. 
J Am Acad Child Adolesc Psychiatry 1994 May;33(4):461-8
Abstract: "RESULTS: Bipolarity developed in 31.7% (N = 25) of the children with MDD..."

George M   
Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. 
Am J Psychiatry 1997 Dec;154(12):1752-6.
Abstract: "These placebo-controlled results suggest that daily left prefrontal repetitive transcranial magnetic stimulation has antidepressant activity when administered at these parameters."

Ghaemi SN, Sachs GS, Chiou AM, Pandurangi AK and Goodwin FK. 
Is bipolar disorder still underdiagnosed? Are antidepressants overutilized? 
J Affect Disord 1999 Jan-Mar;52(1-3):135-44
Abstract: "Systematic application of DSM-IV criteria identified previously undiagnosed bipolar disorder in 40% of a referred population of patients with mood disorders, all previously misdiagnosed as unipolar major depressive disorder.
Web Site Link

Ghaemi SN, Boiman EE and Goodwin FK
Diagnosing Bipolar Disorder and the Effect of Antidepressants: A Naturalistic Study
J Clin Psych 61(10): 804-808, October 2000
Abstract Conclusion: "These results suggest that bipolar disorder tends to be misdiagnosed as unipolar major depressive disorder and that antidepressants seem to be associated with a worsened course of bipolar illness.  However, this naturalistic trail was uncontrolled, and more controlled research is required to confirm or refute these findings."

Gitlin M 
Lithium and the kidney: an updated review. 
Drug Saf 1999 Mar;20(3):231-43
Abstract: "for the vast majority of patients, the renal effects of lithium are benign. Current strategies for minimising the renal effects of lithium include: (i) assiduously avoiding episodes of renal toxicity; (ii) monitoring serum lithium concentrations in order to achieve optimal efficacy at the lowest possible concentration; (iii) monitoring serum creatinine levels on a yearly basis, getting further medical evaluation when the serum creatinine level consistently rises above 140 mmol/L (1.6 mg/dl); and (iv) possibly administering lithium once a day.’

Gittoes NJ, Franklyn JA 
Drug-induced thyroid disorders. 
Drug Saf 1995 Jul;13(1):46-55
Abstract: "Lithium therapy causes overt hypothyroidism in 5 to 15% of patients, and goitre in up to 37%."

Goldberg I. 
Depression central
Website: one of the oldest and most inclusive mental health websites. Well researched. Most of what you’ll find here is pretty solid.
Web Site Link

Goldberg(a) 
Depression central, Borderline Personality Disorder section.
Website: The Borderline section of Dr. Ivan’s extremely detailed site.
Web Site Link

Goldberg(b) 
Depression central, lamotrigine section.
Website: The lamotrigine section of Dr. Ivan’s extremely detailed site.
Web Site Link

Goldberg(c) 
Depression central, topiramate section.
Website: The topiramate section of Dr. Ivan’s extremely detailed site.
Web Site Link

Goodwin FK 
Master educator clinical consultation: treatment of bipolar disorder. 
The 152nd Annual Meeting of the American Psychiatric Association, Washington, DC, 1999. 
Reported in "General Guidelines and Intricacies in the Treatment of Bipolar Disorder" (American Psychiatric Association Annual Meeting, May 20, 1999):
Report on Symposium (full text of report): [a thorough review of treatment principles by a widely acknowledged master].  Web Site Link; register here first if you are not already registered with Medscape, then close that window to return here for the link. 

Goodwin FK and Jamison KR 
Manic-Depressive Illness. 
1990, Oxford Univ Press; ISBN: 0195039343.

Grahame-Smith D. 
Evidence based medicine: Socratic dissent.  
BMJ 1995;310:1126-1127 (29 April)
Full Text link : A whimsical essay invoking Socrates and a more modern colleague, ending with a warning that "evidence-based medicine" not become the "dupe" of political economics. 
 

Griffin LD and Mellon SH 
Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes. Proc Natl Acad Sci U S A 1999 Nov 9;96(23):13512-7
Abstract: [In this very technical presentation, the authors present their research showing that the antidepressant sertraline adds to the existing effects of the progesterone metabolite "allopregnanolone", which is "a powerful anxiolytic, anticonvulsant, and anesthetic agent"].

Herzog AG (a). 
Psychoneuroendocrine aspects of temporolimbic epilepsy: III. Case reports. Psychosomatics 1999; 40: 109-116.
Abstract: "Many reproductive steroids have neuroactive effects that can modulate neuronal excitability and influence emotions. Emotional disorders may result when 1) abnormal endocrine states interact with normal brain, 2) normal endocrine states interact with abnormal brain, and 3) abnormal endocrine states interact with abnormal brain."

Herzog AG (b). 
Psychoneuroendocrine aspects of temporolimbic epilepsy: I. Brain, reproductive steroids, and emotions. 
Psychosomatics 1999; 40: 95-100.
Abstract: "Excessive estrogen influence produces anxiety, agitation, irritability, and lability. It can promote the development of anxiety manifestations (e.g., panic, phobias, and obsessive-compulsive disorder). Progesterone and its metabolites inhibit kindling and seizure activity. They have potent anxiolytic effects, possibly by virtue of their GABAergic activity."

Herzog AG (c) 
Polycystic ovarian syndrome in women with epilepsy: epileptic or iatrogenic? 
Ann Neurol 1996 May;39(5):559-60
Editorial: [His review of the literature suggests that the problem is primarily associated with epilepsy itself, not valproate].

Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr, Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS, Zajecka J
Am J Psych 157(11):1875 (appendix 1), November 2000
Abstract: [This is a screening test for hypomania, agreed upon by these researchers -- a broad sample of opinion -- and presented in this article with data on how well the test performs in detecting but not over-detecting hypomanic symptoms].  

Hokin L. (reported in) 
(1998) New Research Explains Lithium’s Dual Anti-Manic/Anti-Depressive Effect.
Summary of conference: "As reported in the July 7 Proceedings of the National Academy of Sciences, the researchers found that in mice brains, lithium exerts a push/pull effect on the neurotransmitter glutamate, eventually causing it to level off in a stable zone where it can control both extremes.
Web Site Link

Ikonomov OC, Manji HK. 
Molecular Mechanisms Underlying Mood Stabilization in Manic-Depressive Illness: The Phenotype Challenge 
Am J Psychiatry 156:1506-1514, October 1999
Abstract (Review): "Lithium's acute effects are mediated through inhibition of specific enzymes involved in two distinct but interacting signaling pathways–the protein kinase C and glycogen synthase kinase 3ß signaling _cascades–that converge at the level of gene transcriptional regulation. The expression of different genes, including transcription factors, is markedly altered by chronic lithium administration. Chronic lithium treatment also robustly increases the expression of the neuroprotective protein Bcl-2, raising the intriguing possibility that some of lithium's effects are mediated through underappreciated neurotrophic/neuroprotective effects.

Isojarvi et al 
Polycystic Ovaries and Hyperandrogenism in Women Taking Valproate for Epilepsy
The New England Journal of Medicine -- November 4, 1993 -- Vol. 329, No. 19.
Abstract: "Menstrual disturbances, polycystic ovaries, and hyperandrogenism are often encountered in women taking valproate for epilepsy.

Isojarvi et al (b) 
Obesity and endocrine disorders in women taking valproate for epilepsy. 
Ann Neurol. 1996; 39: 579-584.
Abstract: "Valproate therapy for epilepsy is associated with weight gain during treatment in approximately 50% of women patients. The weight gain can be progressive, and is associated with hyperinsulinemia and low serum levels of insulin-like growth factor-binding protein 1, which may lead to hyperandrogenism and polycystic ovaries."

Isojarvi et al (c)  
Valproate, lamotrigine, and insulin-mediated risks in women with epilepsy 
Ann Neurol 1998 Apr;43(4):446-51. 
Abstract : [Suffice it to say that if you've come this far you ought to read the abstract itself; perhaps some might think the authors overstate the degree of certainty warranted at this point, but the data are very important]. 

Jamison, KR. 
Touched with Fire, Free Press; ISBN: 068483183X
Link to this book at Amazon.com

Jacobs AR, Edelheit PB, Coleman AE, Herzog AG 
Late-onset congenital adrenal hyperplasia: a treatable cause of anxiety. 
Biol Psychiatry 1999 Sep 15;46(6):856-9
Abstract: "Some intermediaries of cortisol synthesis, especially the sulfated ester of dehydroepiandrosterone (DHEAS), are picrotoxin-like antagonists of the gamma-aminobutyric acid A (GABA-A) receptor and exert potent anxiogenic effects. CONCLUSIONS: These findings suggest that late onset CAH can contribute to anxiety disorders and that adrenal suppressive therapy or inhibition of steroidogenesis with ketoconazole may be efficacious as adjuvant therapy."

Katon W 
Journal of Managed Care, Spring, 1999

Ketter T(a). 
The Spectrum of Mania; Squaw Valley CA Feb. 1999. 
Dr. Ketter distributed a copy of a poster session , I believe from APA 98, by one of his team. It is not in print nor has the study been enlarged or replicated, to my knowledge. It shows a statistically significant difference in response to valproate between patients with bipolar II who had previously been given an antidepressant, and those who had not: the latter group responded better.

Ketter T(b). 
The Spectrum of Mania; Squaw Valley CA Feb. 1999.

Kilzieh N, Akiskal HS 
Rapid-cycling bipolar disorder. An overview of research and clinical experience. 
Psychiatr Clin North Am 1999 Sep;22(3):585-607
Lengthy technical Abstract: 
"Cumulatively, naturalistic studies over the past 30 years have strongly implicated antidepressants in switching and cycle acceleration... Meanwhile, clinicians may rely on discontinuing antidepressants, maintaining patients on combined mood stabilizers--of which valproate is probably the most useful--and making judicious use of atypical neuroleptics."

Kinney DK et al. 
Pre- and perinatal complications and risk for bipolar disorder: a retrospective study. 
J Affect Disord 1998 Sep;50(2-3):117-24
Abstract: "Results suggest obstetric complications are etiologically significant in bipolar disorder."

Kinrys G. 
 Hypomania Associated With Omega-3 Fatty Acids.  
Arch Gen Psych 2000; 57 (7): (letter; full text online). 

Kline MD, Jaggers ED 
Mania onset while using dehydroepiandrosterone.
Am J Psychiatry. 1999 Jun;156(6):971. No abstract available.

Koerner K, Linehan MM  
Research on dialectical behavior therapy for patients with borderline personality disorder.  Psychiatr Clin North Am 2000 Mar;23(1):151-67.
Abstract: This long abstract gives you a good overview, and the article itself a thorough summary of current thinking about this disorder. 

Kusumakar V et al 
Treatment of mania, mixed state, and rapid cycling. 
Can J Psychiatry 1997 Aug;42 Suppl 2:79S-86S
Abstract: "Electroconvulsive therapy (ECT) is an efficacious and broad-spectrum treatment."

Lazarus JH 
The effects of lithium therapy on thyroid and thyrotropin-releasing hormone. 
Thyroid 1998 Oct;8(10):909-13
Abstract (review): [a very technical discussion, even in the abstract, of what exactly lithium does to thyroid metabolism]
Web Site Link

Lenox RH, Hahn CG 
Overview of the mechanism of action of lithium in the brain: fifty-year update. 
J Clin Psychiatry 2000;61 Suppl 9:5-15  
Abstract: [This is an extensive but very technical review of the changes inside cells that lithium can create; one of them is the MARCKS protein]. 

Leibenluft E 
Women with bipolar illness: clinical and research issues. 
Am J Psychiatry 1996 Feb;153(2):163-73
Abstract (review): "...it is clear that bipolar women are at high risk for postpartum episodes..."

Liebowitz MR 
Cognitive-behavioral group therapy versus phenelzine in social phobia: long term outcome. Depress Anxiety 1999;10(3):89-98
Abstract: "PZ patients entered maintenance more improved than CBGT patients, and nonrelapsing PZ patients maintained their superior gains throughout the study. Relapse during maintenance did not differ between treatments. However, PZ patients showed a trend toward greater relapse during treatment-free follow-up. There was a greater relapse among patients with generalized social phobia with phenelzine."

Linehan M et al.  
Cognitive-behavioral treatment of chronically parasuicidal borderline patients.   
Arch Gen Psychiatry 1991 Dec;48(12):1060-4.  
Abstract:  [This is the original paper by her group; it was a landmark study, the first randomized trial of a treatment for borderline personality disorder.  Follow-up studies have succeeded this one.  For a full overview see this lengthy recent abstract from a 2000 review.]  

Linehan M.  
Cognitive Behavioral Therapy for Borderline Personality Disorder. 
Amazon.com reviews.  Very technical but maybe the best summary there is. 

Letterman L, Markowitz JS    
Gabapentin: a review of published experience in the treatment of bipolar disorder and other psychiatric conditions.  
Pharmacotherapy 1999 May;19(5):565-72 
Abstract: 10 reports and the results of a literature search are reviewed.  The authors conclude "published, well-designed studies evaluating the agent's effectiveness as monotherapy for BD are lacking".    

Manji HK et al. 
Lithium Up-Regulates the Cytoprotective Protein Bcl-2 in the CNS In Vivo: A Role for Neurotrophic and Neuroprotective Effects in Manic Depressive Illness. 
J Clin Psychiatry 2000; 61(suppl 9):82-96.  
Abstract:  "These findings suggest that lithium may exert some of its long-term beneficial effects in the treatment of mood disorders via underappreciated neurotrophic and neuroprotective effects."

Manning JS, Haykal RF, Akiskal HS 
The role of bipolarity in depression in the family practice setting. 
Psychiatr Clin North Am 1999 Sep;22(3):689-703, x
Abstract: "Family physicians inevitably encounter patients with bipolar disorders, often when the patient is depressed. For most of these patients, the attendant elevations in mood fall short of mania. Such milder periods of expansive mood, hypomanias, may go unrecognized unless the physician specifically queries the patient to uncover them. In addition, patients with bipolar disorders often manifest other distinctive characteristics. An understanding of these hints of bipolarity is helpful to clinicians treating depressive illness."

Manning JS et al
On the Nature of Depressive and Anxious States in a Family Practice Setting:  The High Prevalence of Bipolar II and Related Disorders in a Cohort Followed Longitudinally
Comprehensive Psychiatry, 38(2): 102-108, 1997. 
Abstract: The authors provide data demonstrating that family history can help identify bipolar depressions in a family practice setting, as well as their finding that 26% of patients with depression or anxiety had a bipolar variation -- using a semi-structured interview.]

Margolis RL et al. 
Trinucleotide Repeat Expansion and Neuropsychiatric Disease. 
Arch Gen Psychiatry Vol. 56 No. 11, November 1999
Review, full text: [A technical but very up-to-date review of this particular genetic abnormality (repeats) as the potential basis for bipolar and other psychiatric disorders].

McClellen J, Werry J et al. 
  Practice Parameters for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder. 
J. Am. Acad. Child Adolesc. Psychiatry, 1997, 36(l):138-157.
Full Text , courtesy of CABF: "These practice parameters describe the assessment and treatment of early-onset bipolar disorder based on scientific evidence regarding diagnosis and effective treatment and on the current state of clinical practice.

McElroy S
 Detecting and Treating the Spectrum of Mixed Mania and Depression
American Psychiatric Association meeting, May 18 — 21, 1997
Report on Symposium (full text of report): "While manic patients often report euphoria, and depressed patients report anhedonia, both may present primarily with irritability. Distractibility, which is usually reported by manics, can look quite similar to impaired concentration described by depressed patients."
Web Site Link; register here first if you are not already registered with Medscape, then close that window to return here for the link. 

McElroy SL et al. 
A randomized comparison of divalproex oral loading versus haloperidol in the initial treatment of acute psychotic mania.    
 J Clin Psychiatry 1996 Apr;57(4):142-6
Abstract: "Divalproex oral loading [20mg/kg] may produce rapid onset of antimanic and antipsychotic response comparable to that of haloperidol and with minimal side effects in the initial treatment of acute psychotic mania in a subset of bipolar patients." [italics mine]

McElroy SL, Suppes T, Keck PE, Frye MA, Denicoff KD, Altshuler LL, Brown ES, Nolen WA, Kupka RW, Rochussen J, Leverich GS, Post RM
Open-label adjunctive topiramate in the treatment of bipolar disorders.
Biol Psychiatry 2000 Jun 15;47(12):1025-33
Abstract [56 patients, well monitored by the Stanley Foundation Bipolar Outcome Network]. 

Meares R, Stevenson J, Comerford A.  
Psychotherapy with borderline patients: I. A comparison between treated and untreated cohorts  
Australian and New Zealand Journal of Psychiatry  33  (4), 467-472, 1999.   Abstract: Patients who received psychotherapy were significantly improved in terms of the DSM score. Thirty percent of treated patients no longer fulfilled DSM-III criteria for BPD. The untreated patients were unchanged.

Metanoia  Website: An extensive site from a really smart woman with bipolar disorder. If you're thinking about suicide, there's a wonderful letter to read before taking any actions. Go there now if that’s you. Very nicely written, with lots of useful links, even some very funny humor. For example:

CHURCH BULLETIN BLOOPERS
Don’t let worry kill you - let the church help.
Thursday night - Potluck Supper. Prayer and medication to follow.
Remember in prayer the many who are sick of our church and
community.
For those of you who have children and don’t know it, we have a
nursery downstairs.
The rosebud on the alter this morning is to announce the birth of
David Alan Belzer, the sin of Rev. and Mrs. Julius Belzer.
and so forth...

Miller MC, Jacobs DG, Gutheil TG 
Talisman or taboo: the controversy of the suicide-prevention contract. 
Harv Rev Psychiatry 1998 Jul-Aug;6(2):78-87
Abstract: "We recommend an alternative approach to suicide risk management rooted in the well-known and well-defined principles of informed consent."

Moore GJ, Bebchuk JM, Hasanat K, Chen G, Seraji-Bozorgzad N, Wilds IB, Faulk MW, Koch S, Glitz DA, Jolkovsky L, Manji HK  
Lithium increases N-acetyl-aspartate in the human brain: in vivo evidence in support of bcl-2's neurotrophic effects? 
Biol Psychiatry 2000 Jul 1;48(1):1-8.  
Abstract: "These findings provide intriguing indirect support for the contention that chronic lithium increases neuronal viability/function in the human brain". 

Moore GJ, Bebchuk JM, Wilds IB, Chen G, Manji HK
Lithium-induced increase in human brain grey matter.
Lancet 356 (9237), October 2000.  No abstract (research letter). 
[This is a major breakthrough article in a leading journal, by the eminent research team in this field.]

Oliff HS, Berchtold NC, Isackson P, Cotman CW. 
Exercise-induced regulation of brain-derived neurotrophic factor (BDNF) transcripts in the rat hippocampus. 
Brain Res Mol Brain Res 1998 Oct 30;61(1-2):147-53.   
Abstract:  [The authors had rats run for exercise.  The farther they ran, the more their BDNF went up.  Nearly the full effect was seen with 6 hours of running]. 

Perugi G, Toni C, Akiskal HS. 
Anxious-bipolar comorbidity. Diagnostic and treatment challenges. 
Psychiatr Clin North Am 1999 Sep;22(3):565-83, viii
Abstract: "This article describes multiple anxiety comorbidity in the setting of unstable bipolar syndromes... Also described are panic attacks during mania, social phobia followed by hypomania as well as bipolar disorder manifesting as episodic obsessive-compulsive disorder."

Phelps JR. 
Exercise and health maintenance: exactly what is known? 
Western Journal of Medicine 1987 Feb; 146: 200-206. 
[This is a paper I wrote as a medical student, that led me into mental health — because the effects of exercise on mood are among the best researched! However, it’s hard enough to get people who aren’t depressed to exercise, so expecting people with mood disorders to do so without great support is unrealistic.]  Note that 12 years later the Surgeon General of the United States wrote the same article, so to speak: http://www.cdc.gov/nccdphp/sgr/sgr.htm

Phelps JR
(unpublished data, presented at "Making it Work: Primary Care and Mental Health", Oregon Office of Mental Health Services-sponsored state-wide conference, Oct 2000). 

Post RM 
Rational polypharmacy in the bipolar affective disorders. 
Epilepsy Res Suppl 1996;11:153-80.
Abstract [but long]: "We suggest the initial use of acute adjuncts to lithium with the anticonvulsants carbamazepine or valproate (instead of neuroleptics)".

Piontek C and Wisner K  
Appropriate Clinical Management of Women Taking Valproate.  
J Clin Psychiatry 61:(3), 161-163, March 2000.  
Not online.  Summary: The authors strongly caution about potential risk of creating hormonal shifts and polycystic ovarian syndrome with valproate, not on the basis of clear data, which they point out is lacking; but rather on the basis of increasingly suggestive studies, especially the recent valproate-to-lamotrigine study ^Isojarvi(c) .  

Rao U et al 
Unipolar depression in adolescents: clinical outcome in adulthood.
 J Am Acad Child Adolesc Psychiatry 1995 May;34(5):566-78
Abstract: "RESULTS: The depressed group showed high rates of recurrence of MDD episodes during the interval period (69%). They also had elevated rates of new-onset bipolar disorder (19%)."

Rasgon N, Altshuler L et al   
Medication Status and Polycystic Ovary Syndrome in Women With Bipolar disorder: A Preliminary Report  
J Clin Psych 61:(3)173-178, March 2000
Not online.  (Here's her summary that is online). Summary:  22 women, half on lithium, half on valproate.  No difference in rate of endocrine abnormalities.  Clear polycystic ovary syndrome changes in none.  See commentary by Piontek and Wisner in same issue, taking a much more concerned stance. 

Rubinow DR, Schmidt PJ, Roca CA 
Estrogen-serotonin interactions: implications for affective regulation.
Biol Psychiatry 1998 Nov 1;44(9):839-50 
Abstract: "we summarize the putative roles of estrogen and serotonin in two reproductive-endocrine-related mood disorders: premenstrual syndrome and perimenopausal depression."

Sachs G. (a) Psychiatric Grand Rounds, Salem Memorial Hospital, OR 1999

Sachs G (b). in "Medication Controversies in the Treatment of Bipolar Disorder"; "Bipolar Depression" section, 7^th paragraph (1999 APA symposium)
Report on Symposium: [scroll down to Sachs on Bipolar Depression, for the his view of antidepressants and Neurontin.]
Web Site Link; register here first if you are not already registered with Medscape, then close that window to return here for the link. 

Sachs (c) et al.  
Medication Treatment of Bipolar Disorder 2000.  Expert Consensus Guideline Series.  Postgraduate Medicine, April 2000.  McGraw-Hill.  
You can download a PDF version from this site, although it seems to take a while and you'll probably have to print it to read it! 

Sachs G (d)  
quoted extensively in "Use Antidepressants Cautiously for Bipolar Depression", a report of Dr. Sachs presentation at the 1999 meeting of the American Psychiatric Ass'n.  [Highly recommended read] Website Link.  

Sackett DL et al. 
Evidence based medicine: what it is and what it isn't. 
BMJ 1996;312:71-72 (13 January)
Full text, editorial: A nice description of "evidence-based medicine". See the next to last paragraph for the role of the randomized clinical trial. This brief summary of how to do medicine using information is worth reading; remember, you can access the whole thing right here with a click.

Satcher D 
Mental Health: A Report of the Surgeon General
An 8-chapter work of massive scope. Read the introduction, preface and forward, and skim the main points, introduced in chapter one.
Web Site Link

Schwartz J. 
Brain Lock : Free Yourself from Obsessive-Compulsive Behavior : A Four-Step Self-Treatment Method to Change Your Brain Chemistry. 
HarperCollins (paper); ISBN: 0060987111 Paperback - 219 pages (March 1997), $13.00.
Paperback: Lots of case descriptions illustrate the four-step technique used by the UCLA OCD clinic.
Amazon book link

Schwartz JM et al.  
Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder.  
Arch Gen Psychiatry 1996 Feb;53(2):109-13  
Abstract: This is a "landmark" study.  It shows visual clear evidence of a "change in brain chemistry" with treatment, in this case for obsessive compulsive disorder. The twist: it was a behavioral therapy that is associated with the change.  Right, not a medication but a "psychotherapy".   

Sichel D and Driscoll J.  
Women's Moods.  
Paperback due in December 2000 for half the price.  
Hardcover - 384 pages (December 1999).
ISBN: 0688148980    Read reviews at Amazon.com

Sobo S. 
Mood Stabilizers and Mood Swings: In Search of a Definition 
Psychiatric Times October 1999 Vol. XVI Issue 10.
Essay:  an educated clinician speaks here for the skeptics.  Update 2/2006: His original essay in Psychiatric Times is an important historical touchstone; in addition, he has taken that essay and updated it on his own site. Combining his view with the experts I cite represents the full spectrum of debate about the "bipolar spectrum". Other writings from Dr. Sobo are collectively referenced at Bipolar World. 
Web Site Link

Soloff PH.  
Psychopharmacology of borderline personality disorder 
Psychiatr Clin North Am 2000 Mar;23(1):169-92, ix
Abstract: "... Drugs in each medication class have some potential utility against specific symptoms in patients with borderline personality disorder."

Sotsky SM, Simmens SJ 
Pharmacotherapy response and diagnostic validity in atypical depression. 
J Affect Disord 1999 Aug;54(3):237-47
Abstract: "This study provides evidence for the predictive validity of atypical features of major depressive disorder, including mood reactivity and at least one reversed vegetative symptom of either hypersomnia, hyperphagia, or weight gain..."

Steffens DC, Byrum CE, McQuoid DR, Greenberg DL, Payne ME, Blitchington TF, MacFall JR, Krishnan KR
Hippocampal volume in geriatric depression
Biol Psychiatry 2000 Aug 15;48(4):301-9
Abstract: [The authors conclude] " these results support a role for hippocampal dysfunction in depression, particularly in late-age onset depression."

Stoll A et al 
Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry 1999 May;56(5):407-12
Full text: the only randomized trial of this approach: good design, small numbers, useful review of intracellular mechanisms of mood stabilizers (which led to this trial in the first place!).

Stoll A et al  
Reply to Kinrys.  
Arch Gen Psych 2000; 57 (7): (letters; full text online). 
[Though they downplay it, note that they saw around 10 cases out of 300 that might have been hypomania induced by this food supplement. They agree it may be a better antidepressant than antimanic.]

suicide (a): National Depressive and Manic Depressive Association
Website: a thorough discussion from people who know both sides (having desired to commit suicide, and now wanting others not to).
Web Site Link

suicide (b)
Website: "if you are feeling suicidal now, please stop long enough to read this. It will only take about five minutes.
Web Site Link

Swann A.  
Interview in Bipolar Disorders Letter, February 2000. 
 "Previous Episodes and Response to Antimanic Drugs". 
Supplement to Psychiatric Times, CME, Inc.
Article:  About halfway through the article, after the quite technical stuff at the beginning, the cited quotes appear.   Link to Article

Swann et al.  
Differential Effect of Number of Previous Episodes of Affective Disorder on Response to Lithium or Divalproex in Acute Mania  
Am J Psychiatry 1999 156: 1264-1266.
Abstract:  The data seem to indicate that having many bipolar episodes leads to resistance to lithium.       

Texas Medical Algorithms Project: bipolar algorithm.
Diagram: [the typical progression of treatment for bipolar disorder generally; does not separate bipolar II].
Web Site Link

Tohen M et al. 
Olanzapine versus placebo in the treatment of acute mania 
Am J Psychiatry 1999 May;156(5):702-9
Abstract: [the first large randomized trial to show acute antimanic efficacy for olanzapine; this group has gone on to show sustained efficacy over 1 year in some of these patients].

Weiss EL et al  
Testosterone-patch-induced psychotic mania.
Am J Psychiatry. 1999 Jun;156(6):969. No abstract available.

Weyerer S, Kupfer B 
Physical exercise and psychological health. 
Sports Med 1994 Feb;17(2):108-16
Abstract(Review): "Several studies indicate that mental health can be improved by low- or moderate-intensity activity."

Wilmink T, Frick TW  
Drug-induced pancreatitis.  
Drug Saf 1996 Jun;14(6):406-23.  
Abstract 

Wirshing DA et al. 
Novel antipsychotics: comparison of weight gain liabilities. 
J Clin Psychiatry 1999 Jun;60(6):358-63.
Abstract: "Clozapine- and olanzapine-treated subjects appeared to gain weight over a prolonged period of time".

Wolpert EA et al 
Efficacy of electroconvulsive therapy in continuous rapid cycling bipolar disorder. 
Psychiatric Annals 29: 12/December 1999: 679-683 
[A series of six cases. The woman who had ECT within months of onset of cycling had a complete remission lasting 4 years so far, whereas several people who had cycling for years responded well but relapsed quickly, and one who had symptoms for about 20 years did not respond].

Woolley CS
Effects of estrogen in the CNS. 
Curr Opin Neurobiol 1999 Jun;9(3):349-54
Full text is available through BioMedNet, but this is extremely technical stuff.  It probably isn't worth chasing the full text unless you're pretty comfortable with neuroscience.
Abstract: "Findings in these areas demonstrate a role for estrogen that goes beyond direct control of reproductive function."

Yatham LN et al 
Bipolar depression: treatment options. 
Can J Psychiatry 1997 Aug;42 Suppl 2:87S-91S
Abstract: "Almost all antidepressant treatments with the exception of mood stabilizers have been reported to induce a manic-hypomanic switch and rapid cycling."

Young DM 
Psychiatric morbidity in travelers to Honolulu, Hawaii. 
Compr Psychiatry 1995 May-Jun;36(3):224-8
Abstract: "East-bound travelers were significantly more likely to show symptoms of mania than controls (P < .001). In an eastbound-versus-westbound comparison, significantly more eastbound travelers showed symptoms of mania, whereas significantly more westbound travelers showed symptoms of depression (P < .05)." [Note how much stronger the eastward/mania effect seems, per the p-values].

Young LT et al  
Double-Blind Comparison of Addition of a Second Mood Stabilizer Versus an Antidepressant to an Initial Mood Stabilizer for Treatment of Patients With Bipolar Depression  
Am J Psychiatry 157:124-126, January 2000
Abstract: Both treatments were equally effective, but there were more dropouts due to side effects in the add-a-second-mood-stabilizer group.  

Zarate C.  
Bipolar Disorders Letter, February 2000.  "Ask the Expert" section. 
Supplement to Psychiatric Times, CME, Inc.
Article:  A response to the question "why do you suppose Neurontin has not been studied more for use in bipolar disorder?"      Link to Article