Thanks for keeping us up to date with what is going on in the world of psychiatry. I've been using your newsletter (and now your blog) as a source of useful information for a couple of years now as has my partner who found your information valuable during her first degree course in counselling studies. I've been able to take information to my psychiatrist and it is never a bad thing to be as well informed as possible! I'm looking forward to hearing more about what you are learning soon **************************************************** Hi Virginia, I've just spent an afternoon talking up a storm with some of the leading mood disorders experts in the world. In in the press room now, catching up on my emails, then I'm off to a dinner symposium on the fine points of neurocognition. Bipolar disorder is way more than a mood disorder, so I hope this symposium will shed some light on how our thinking is thrown out of whack. Hope to have another report very soon ... John

Lithium is an “efficacious” treatment, he said, but is not “highly effective.” If Dr. Sachs did indeed say this, it is sad because it is wrong. No BP med has shown better and I fear Sachs may have become to cozy up with drug companies who don't profit by lithium. ********************************************* Hi, Stella. Excuse the confusion. He said this in the context of patients dropping out of treatment. So here's the catch: you can have a great (efficacious) treatment, but if patients don't give it a decent trial for various reasons then it is not effective. There is a distinction between efficacy and effectiveness. The drug companies run "efficacy" trials, that is they test their products on model populations (suicidal patients, patients with medical complications, patients with co-occurring psychiatric illnesses, etc) are weeded out. In short, they are nothing like the patients psychiatrists see in their practices. Also, the treatment is "model" treatment - frequent psychiatric visits, thorough exams. An "effectiveness" trial, on the other hand, is what Dr Sachs and his colleagues have recently completed. They've been testing how various treatments work in the real world, but with top psychiatric care. Bottom line: If we can optimize the relationship patients have with their psychiatrists the meds will work better. Efficacious meds will become effective. Believe me, Dr Sachs is no drug industry lackey. Yes, lithium often gets overlooked by psychiatrists because 1) it is more trouble for psychiatrists to work with, and 2) the drug companies are promoting their expensive proprietary meds. Frederick Goodwin MD, who co=authored the definitive work on bipolar - at a session at the APA annual meeting - said that any psychiatrist who won't work with lithium shouldn't be seeing patients with mood disorders. John