This text is a unique case-based review, using life charts of patients' treatment experience, of the course and treatment of bipolar illness by two well-established experts. The book's approach to bipolar disorder (manic-depressive illness) grew out of the authors' clinical experience with treatment-refractory patients, who were evaluated, studied, and treated at the Biological Psychiatry Branch of the National Institute of Mental Health in Bethesda, Maryland. The observations and insights by Dr Robert Post and Ms. Gabriele Leverich are informed as well by the work of the Bipolar Collaborative Network, which was supported by the Stanley Medical Research Institute.

The Introduction highlights the problems associated with lithium carbonate and its limited effectiveness as monotherapy in maintaining remission in bipolar disorder and emphasizes the requirements for adjunctive combination therapy in the long-term management and treatment of bipolar disorder. The authors summarize longitudinal studies, which have demonstrated that less than 50% of patients had maintained stability and were in remission overall, even when treated with lithium carbonate in combination with carbamazepine or valproate. This statistic is consistent with this reviewer's clinical experience.

The full text is divided into 17 parts including seven appendices and 69 chapters. In Part I, chapter 1, the authors offer an elegant overview of the descriptions of melancholia and mania, highlighting Kraepelin's observation, ‘that the attacks of manic-depressive insanity … never lead to profound dementia, not even when they continue throughout life without interruption’. Kraepelin also described the variability and unpredictability of illness evolution, including the observations that the well intervals between episodes tend to become shorter and that episodes become progressively more independent of precipitating factors.

Part II contains seven chapters on illness course, the role of psychosocial stressors, and the impact of treatment on the overall outcome of the disorder in any individual. In chapter 2, Dr Post and Ms. Leverich describe the pattern of cycle acceleration as illustrated by the use of their life chart method (LCM). In chapter 3, the authors focus on the development of more frequent depressive intervals and hypomanic phases over time, consistent with bipolar II disorder or a bipolar NOS diagnosis. These conditions are ultimately responsive to alternative and novel mood-stabilizing anticonvulsant treatment. In chapter 4, the authors depict the effect of delayed introduction of efficacious mood-stabilizing treatment for many individuals with bipolar disorder, especially those with childhood-onset depressive episodes. The complex issue of co-morbid post-traumatic stress disorder and manic-depressive illness is delineated in chapter 5 with the authors' assertion that systematic study of optimal treatment for this co-morbidity is absent. Chapters 6 and 7 emphasize the role of stressors and how they initiate recurrent episodes and destabilize maintenance treatment in bipolar disorder. In chapter 8, the authors describe loss of response to a previously effective drug as pharmacodynamic tolerance. They distinguish two patterns of treatment resistance: (1) loss of efficacy due to a tolerance process, and (2) treatment-discontinuation-induced refractoriness, as it occurs with lithium discontinuation in a percentage of cases.

Part III includes chapters 9 and 10, in which the fundamentals of pharmacology, genetics, and biology of bipolar illness are carefully reviewed. Part IV involves a review of response to all mood-stabilizing treatment including lithium, carbamazepine, valproic acid, and lamotrigine. The authors are explicit in detailing the process of initiating and monitoring treatment with mood-stabilizing medication and in managing side-effects of the treatment. Part V reviews the use of other anticonvulsants, which have been studied in bipolar illness. Part VI addresses the novel use of calcium channel antagonists in bipolar disorder.

A comprehensive overview of other treatments used in bipolar disorder including all antidepressants, benzodiazepines, typical and atypical antipsychotic medication, electroconvulsive therapy, dietary and other supplements, and other somatic treatments including transcranial magnetic stimulation, vagus nerve stimulation, and sleep deprivation are presented in Parts VII to XVII. Additional topics addressed in this impressive text include the impact of alcohol and drug use in bipolar disorder, the role of complex combination pharmacotherapy, and treatment of children with bipolar disorder.

This casebook approach to bipolar illness represents a compendium of all current standard and experimental treatments of the illness. The neurobiological aspects of the disease and its treatment are well explicated. More reference to the psychosocial treatment approaches including comprehensive cognitive behavioural therapy (CBT), interpersonal social rhythm therapy (IPSRT), or family-focused psychotherapy and psychoeducational treatment is needed. All have proven to be effective adjunctive treatments in the management of bipolar illness. There are numerous points of repetition at the end of each chapter, which are intended to emphasize the critical aspects of each case. Dr Post and Ms. Leverich provide outstanding tables of reference for each class of medications and offer a sample consultation, which reflects their thoughtfulness, systematic care, and empirically based experience with all of the treatment approaches in bipolar disorder. The text is authoritative, unique, and well-written. Clinicians, students, residents, and experts knowledgeable in bipolar illness will appreciate the authors' clarity and perspective on the diagnosis, course, and management of this often complex illness.