Cinders, you shall go to the ball

Goodwin has described bipolar disorder as the Cinderella of psychiatry, largely on the basis of his study showing the relative paucity of research studies in bipolar disorder compared with schizophrenia (Goodwin, 2000). This study has been reinforced by Clement et al (2003), who similarly concluded that bipolar disorder is underrepresented compared with schizophrenia and that this disparity is not declining over time. The importance of this discrepancy is demonstrated by the finding that bipolar disorder causes a greater global burden of disease than schizophrenia (Murray & Lopez, 1997) and by the huge financial impact of bipolar disorder on society (Das Gupta & Guest, 2002)

Clement and colleagues appear to lay the responsibility for the relative lack of bipolar research on a national shortage of specialist clinical services and on the lack of interest of researchers. However, clinical services such as our own in the Northern Deanery are flourishing and we suggest that historical difficulties in obtaining public funding for bipolar disorder are of greater impact. Clement et al examined citations in 5-year periods from 1966 to 2000. However, examination of Medline citations on an annual basis between 1996 and 2002 shows that the relative difference between research in bipolar disorders and schizophrenia may be becoming smaller. It appears that this has not been driven by a change in priorities of public funding bodies but rather by the presence of a private organisation, the Stanley Medical Research Institute, which funds approximately half of all US studies in bipolar disorder and has provided US$130 million for research since its inception in 1989. This timely report by Clement and colleagues should serve as a rallying call to governments and charitable funding bodies to give bipolar disorder the priority it demands.