Welcome to the Psychiatry and Psychotherapy Podcast. The podcast to help you in your journey

towards becoming a wise, empathic, genuine and connected mental health professional.

I'm your host, Dr. David Puder, a psychiatrist who splits his time practicing psychopharmacology,

individual and group psychotherapy, medical director of a day treatment program,

medical education research, and teaching residents and medical students.

In this episode, I'm back with Dr. Cummings. Dr. Cummings, welcome back.

Thank you very much. I'm glad to be back with you.

Today, we're going to be talking about mood stabilizers and bipolar and the history of it and the treatment

and kind of the nuance of some of the medications, whether you're a psychiatrist and NPAPA or, you know, someone in training.

I think this would be very valuable. And if you're a therapist, I think it'll be very valuable to know what are the different medications.

We'll talk about some of the side effects how they would interact potentially with therapy, with the brain, with brain function.

And we'll also talk about the role of therapy within a true bipolar disease. And yeah, so Dr. Cummings, welcome to the show.

Thank you very much.

Bipolar illness was really first described also by Emil Crepolin, the same man who described schizophrenia in the 19th century.

And indeed, the patients he was seeing, he was able to divide into those who had a chronic psychotic illness, which without anti-psychotics had a pretty uniformally deteriorating course.

But then he noticed that there was another major mental illness in which people had episodic disturbances of mood, either elevation of mood and increased energy decreased need for sleep, often impulsive or sometimes psychotically related behaviors.

And on the other pole, people who became also depressed at times became energy, hypersonal and in many cases.

And the illness he described was then as now cyclic in nature, people would have episodes of either mood elevation or depression separated by variable periods of time of normal functioning.

And he indeed described that as manic illness or mania. And indeed to this day, the DSM identifies by polar illness primarily by the presence of at least one episode of mood elevation to help distinguish it from unipolar or major depressive disorder.

Yes, I think you said a couple things there that are really insightful. One is that in between episodes, you know, patients are fairly normal.

And when they're manic, you know, their mood elevates, their lack of sleep, so they're sleeping, you know, maybe at first four to five hours a night and then three to four and then, you know, not sleeping at all.

And one thing I'd like to say is that every true manic episode will end in three places, death, jail or hospitalization of some type.

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