He cited clinical suggestions of progression to more treatment-resistant forms of disease. "You often see the history that initial treatment with antidepressant drugs helped, but later they did not." For example, in a recent meta-analysis of 12 treatment studies involving more than 4,000 total patients with bipolar disorder, Dr. Berk and his associates found patients in the earliest stages of their disease consistently had better responses to treatment, compared with patients who had experienced more episodes of mania or depression. "Vigorous attention needs to be paid to early diagnosis," they wrote in their report published earlier this year (Bipolar Dis. 2011;13:87-98). "There is every possibility that early and appropriate treatment and the prevention of new episodes may prevent this cascade," they wrote, but also added "this remains to be established."
Dr. Berk said he had been a speaker for, a consultant to, and has received research grants from Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, and Servier; he has been a speaker for and consultant to AstraZeneca, Janssen Cilag, and Lundbeck; he has been a speaker for Merck, Sanofi Synthélabo, and Solvay and Wyeth, and he has received research grants from Organon, Novartis, and Mayne.