Bipolar Medications: Mechanisms of Action Edited by Husseini K. Manji, Charles L. Bowden & Robert H. Belmaker. Washington, DC: American Psychiatric Press. 2000. 440 pp. £46.95 (hb). ISBN 0 88048 927 8

To both clinicians and researchers bipolar affective disorder is a fascinating topic for study. Bipolar disorder interfaces with every area of psychiatry, childhood and elderly forms are well recognised, there is a clear overlap with both schizophrenia and unipolar disorder and also a significant comorbidity with addictions and personality disorders. Most major classes of psychotropic drugs have been used for the treatment of this disorder and it has been argued that the psychopharmacological revolution was initiated by the discovery by John Cade in 1949 of lithium as a treatment for mania. Lithium, of course, remains the gold standard against which all other treatments of this disorder must be measured.

It is with the subject of bipolar medications and their mechanisms of action that this volume edited by Manji, Bowden & Belmaker, three leading US researchers, is concerned. In it they seek to understand lithium and other ‘bipolar’ medications such as the anticonvulsants and atypical antipsychotics. If we understood how these treatments work we would have a better grasp of the neural basis of this devastating disorder. Despite 50 years of research we still do not really understand the action of lithium or of any of the other putative mood stabilisers. However, this volume investigates most of the major leads and reviews results from clinical studies of lithium withdrawal and evidence of the efficacy of new treatments.

This is predominantly a North American textbook, with a few contributions from Israel and the occasional chapter from the UK, Denmark, Canada and Japan. Contributors are mostly academic psychiatrists, basic scientists interested in this area and representatives from the pharmaceutical industry who are primarily concerned with the development of new treatments.

Overall, this is a very good book for the aficionado. It is frustrating that many of the chapters take a rather blinkered view of the various medications' mechanisms of action, often seeking to explain them entirely within a single frame of reference. There is no attempt to integrate the plethora of different findings and the book would be considerably enhanced by an authoritative concluding chapter by the editors. Notwithstanding this caveat, the book is a mine of information that should be purchased by departmental libraries. And although I would not recommend that trainees buy it, they should dip into a library copy, as might established consultants and students.