The impact of mood stabilizers on bipolar disorder: the 1890s and 1990s compared.

This study comparing patterns of service utilization by bipolar patients in North-West Wales found a greater prevalence of service utilization in the 1990s compared with the 1890s. In the pre-lithium era, admissions for bipolar disorders occurred at a rate of 4 every 10 years; they now occur at a rate of 6.3 every 10 years. Where 100 years ago, there were 16 bipolar patients per million population resident per day in hospital, there are now 24 per million resident in acute service beds and more in non-acute beds. These data are incompatible with simple claims that mood stabilizing drugs 'work'. An alternative is that these agents have treatment effects, and further research is needed to match treatments to patients in order to optimize outcomes.