Commentary on N. Ghaemi's "Hippocratic Psychopharmacology of Bipolar Disorder" Treating Bipolar Disorder: For the Patient or Against the Illness?

OBJECTIVE

This is a commentary on Hippocratic Psychopharmacology in Bipolar Disorder, an article by S. Nasir Ghaemi in this issue of Psychiatry 2006.

DESIGN

Based on Dr. Ghaemi's article and relevant literature, I discuss implications of Hippocratic treatment, i.e., the principle of treating an underlying illness using methods that enhance the patient's adaptive responses, rather than using symptomatic treatments.

RESULTS AND DISCUSSION

Key points include 1) the course of illness, as heterogeneous as it is, seems to have episodic-stable and inherently unstable forms; 2) course of illness interacts with episode characteristics, with mixed or polyphasic episodes associated with an unstable and complicated course of illness; 3) consequences in terms of treatment response, with lithium being more effective in treating the episodic-stable than the unstable form of the illness; and 4) the fact that, in determining treatment response, course of illness trumps episode characteristics. The goal of Hippocratic/Oslerian medicine, curative treatment aimed at underlying mechanisms of disease, is the aim of treatment, but is still elusive.