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.