Clinician’s Guide to Bipolar Disorder: Integrating Pharmacology and Psychotherapy

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Reviewed by James Phelps, MD

by David J. Miklowitz and Michael J. Gitlin;
New York: Guilford Press; 2014
324 pages • $34 (hardcover)

This book is perfect for someone. Not clear who, though. It’s a masterful review from two well-known specialists, each in his respective domain: bipolar-specific psychotherapy and pharmacology. Moreover, as the title declares, the authors attempt to integrate these two fundamental ingredients in the treatment of bipolar disorders.

The result, however, is like a hybrid bicycle, neither mountain bike nor road bike: able to go off the traditional roads (as in its emphasis on the central role of psychotherapy in the treatment of bipolar disorders, to which we can say “Amen! Finally!”) and able to ride well on the pavement (as in the usual recommendations on pharmacotherapy, but lacking in depth relative to more specialized texts on each of these domains, such as the authors’ previous works.

Nevertheless, those who would ride a bike will only be able to buy one, and that bike must be able to cover a lot of ground, albeit with some sacrifices. For approaching the landscape of bipolar disorders in that way, this book is likely one of the best vehicles.

And yet, who among us will turn to only one resource on bipolar disorders? A medical student on her psychiatry rotation would find this a superb overview, but it would require a very motivated student to get through this, along with everything else she would be invited to read during that all-too-brief experience.

A psychotherapist? He would hopefully want much more detail on the psychotherapeutic approaches-eg, reading Miklowitz’s monograph on family-focused therapy and the masterful psychoeducation manual from Drs Vieta and Colom, as well as reading on bipolar-specific cognitive-behavioral therapy and social rhythm therapies.

A psychiatrist? A resident-in-training would do well to read this entire volume, the organization of which so clearly emphasizes using both psychotherapy and pharmacotherapy. And yet, do we trust a second-year resident to really read a text like this? (Surely we’d want them to be well-versed in these concepts by their third year; and the first year is so full of other rotations as to make this book appear irrelevant-which of course it is not, given the prevalence of mood disorders.) However, if this book is only browsed, it is too superficial-its value lies in seeing the whole that it describes.

Finally, potential readers should be aware that controversial areas of bipolar treatment are handled rather unilaterally. The authors’ treatment of the “bipolar spectrum” concept is remarkably dismissive (“essentially no studies at all”). The non-manic bipolar markers (family history, age of onset, course of illness, response to treatment), fully accepted by several teams of reviewers from the International Society for Bipolar Disorders after their review of the literature, are also dismissed, again citing “insufficient research.” Likewise, the authors present antidepressants as relatively innocuous in bipolar II: If the patient is hypomanic while taking them, just turn them down a little; and if that doesn’t work, add aripiprazole and zolpidem for a while, then proceed as previously.

Nevertheless, the very existence of this book is a landmark in itself, reflecting full recognition that bipolar treatment requires both effective psychotherapy and effective pharmacotherapy. For this, and for their long-standing efforts to advance treatments in each realm, we can be grateful to Drs Miklowitz and Gitlin.