ABSTRACT
If we took the literature on bipolar disorders at face value, we would have to conclude that over time the outcome of long-term treatment has become much worse. While the earlier reports showed very promising results with 75% of bipolar patients benefiting from long-term lithium treatment,1 recent findings have been very discouraging, suggesting response rates between 20 and 35%. However, these numbers are not directly comparable, primarily because of major shifts in the patients under study. Bipolar disorders are now diagnosed much more broadly and more frequently, as a bipolar spectrum, with negative implications for outcomes. In this brief chapter I will review the observations indicating that the current unsatisfactory outcome can be markedly improved by recognizing the striking heterogeneity of bipolar disorders and by selecting the treatment for each individual according to a characteristic clinical profile.
