PsychEducation.org
     Extensive Mental Health Information on Specific Topics 
                                    Jim Phelps, M.D.                                               Corvallis, OR                      (home)         

"What's New" 

Update 5/2009: I've gone back to work for my local hospital with the advent of their residency training program in Psychiatry. Entries will be few and far between for a while! 

Here's the list of what was added to this website, and when.    

• Added MoodPanda to the electronic charting page, and BeatingBipolar.org, a research application with nice features. (2/2012)
• Added a Help with Research page linking some survey work done at Cardiff University (1/12)
• Updated the references for the Bipolar Spectrum Diagnostic Scale validation studies on the MoodCheck page (1/2012)
• Updated the NAC page with a summary of a recent email exchange with three NAC researchers whom I asked for information on long-term risks. . (1/2012)
• Added a new section in Thyroid Details showing schematic curves for the distribution of TSH in the adult population (as the basis for interpreting TSH of 1.0 as the ideal value, the "most normal" value). (12/2011)
• Added an important new reference to the discussion of bone density risk when using thyroid hormone, to the Thyroid and Bipolar and the High Dose Thyroid pages (12/2011)
• Revised the Light Therapy page with the newest light box recommendations and prices (12/2011)
• Rewrote the Dawn Simulators page with 2011 prices and links. (10/2011)
• Breaking News, Readers Digest recommends amber lenses. Whoops, wrong model. Amazing. Added a brief description of this remarkable event, with the link they suggested and why it's not a great idea, to the Darkness and Light page, lenses section. (10/2011)
• Added a brief new section to the Diagnosis page on length of hypomania, based on a new study (10/2011)
• Moved fish oil research studies to another page; included a recent meta-analysis suggesting that EPA should be 60% of the total omega-3 dose (9/2011)
• Added a chart of bipolar depression symptoms to Diagnosis page (6/2011)
• Added a link to the new Bipolar Caregivers site from Australia (3/1011)
• Updated some references on the bone density page, a subpage off the larger discussion of risks of high dose thyroid for rapid cycling. (3/2011)
• Added a lovely review on blue light research history to the Light and Dark page (2/2011)
• Minor update in the retinal safety section of the Light Therapy page (1/2011)
• Added a case report on nasal steroids causing manic symptoms to the steroid section of Treatment Details. (12/2010)
• Updated the NAC (n-acetylcysteine) page with a new review and more thorough search for a low price (12/2010)
• Updated the page on lamotrigine rashes with a new article on re-trying the medication after a rash problem (12/2010)
• Updated all the dawn simulators, sources and prices (12/2010)
• Updated the page on electronic mood charting (11/2010)
• Added a page introducing Chronotherapy and linking a Chicago expert's website on this subject (10/2010)
• Added a new page on Stopping Antidepressants in Bipolar Disorder: 31 Guidelines (8/2010)
• Updated the n-acetylcysteine page again with new references re: safety and conditions treated. (1/2010)
• Linked the first iPhone mood tracking application (12/2009)
• Updated the thyroid/bipolar page with a new reference suggesting that low-but-normal thyroid levels may be worth treating in some people. (10/2009)
• Updated the Borderline vs. Bipolar page with a new lamotrigine reference (effective in "borderline" patients) and a updating summary (9/2009)
• Updated the divalproex (Depakote) and Polycystic Ovarian Syndrome data with a brief summary of the new consensus on this issue (9/2009)
• Added the newest examination of stay-on or stop the antidepressant to Controversy 3 on the Antidepressant Controversies page (9/09)
• Added another model to the list of dawn simulators (6/09)
• Finished and polished the study of lamotrigine's effectiveness versus placebo (3/09)
• Updated my page on how complex the thyroid system is: new data on T4's direct role (3/2009)
• Revised the Electronic Mood Charting page to include some other such programs, compared; see the green table on that page. (2/2009)
• Added a few paragraphs on keeping a job to the Treatment Details page, including reference to a study of what helps (1/2009)
• Added a study of lamotrigine's effectiveness versus placebo, a "meta-analysis" that matches clinical experience (1/2009)
• Added a page on n-acetylcysteine (NAC) to the Mood Stabilizers list (1/2009)
• Added a new study to the verapamil page (1/2009)
• Revised the MDQ page to include a new reference and a link to the MDQ itself on the Depression and Bipolar Support Alliance website (1/2009)
• Added the long-term follow-up data to the previous information (now on it's own page) on lamotrigine versus olanzapine/fluoxetine combination (1/2009)
• Reviewed and updated the Mood Stabilizers page (1/2009)
• Revised the Funding page for 2009 (1/2009)
• Updated the Light Therapy page with information about the green-light visor approach. (12/2008)
• Updated the Light Therapy page with information about a cheap new blue-light box for $50. Thanks to Sean for the link. (11/2008)
• Added some new information on light levels -- indoor and outdoor -- to the top of the Light Therapy page (11/2008)
• Lamotrigine generic: is it as good as the trade-name version? Here's a summary of recent data on that (10/08)
• Added a nifty graph on the experience of hypomania to the main page on diagnosis, with a new section of that page to match (10/08)
• Reviewed, revised and updated the valproate/Depakote page now that it is generic in the divalproex form (10/08)
• A short essay about transcranial magnetic stimulation on the occasion of its FDA indication (10/08)
• Added a link to the Washington State program which helps primary care doctors diagnose and treat children; to the Primary Care Resource Center (10/08)
• Added another dawn simulator to the list, the cute little Verilux lamp. (10/08)
• Added a brief update on lamotrigine: does the generic version work as well as the brand name?  (10/08)
• Added to the story of the molecular basis of mood and anxiety:   PTSD risk is affected by the same gene difference already recognized to influence depression risk -- the serotonin transporter gene. See Chapter 2 (where the start of this story about genetic risk is Chapter 1). (9/2008)
• When stopping an antidepressant, how long should you take to taper it off? Four months? That's been my recommendation. Now here are some data, albeit indirect, to back that up. (9/2008)
• Revised the serotonin transporter page to include the effect of gender (who's more likely to get depressed when stressed? Not what you think) (9/2008)
• Here's an examination of some of the other findings in Zimmerman's "overdiagnosis" paper that was reported in the L.A. Times (8/2008)
• Revised and corrected the explanation of biological clock mechanics, including the role of lithium in restoring clock function (8/2008).
• Added an important new reference to the Antidepressant Controversies page, describing the research study by Amsterdam and colleagues using venlafaxine aversive lithium for Bipolar II depression.  A key graph is shown. (7/2008)
• Added another point of view following the testimonial on the TrueHope page (7/08)
• Updated the fish oil page with an additional safety reference (the Environmental Defense Fund, of all places) and some comments suggested by a colleague; Safety section (6/08)
• Added another reference favorable to the use of antidepressants in bipolar depression to the Antidepressant Controversies literature collection (bottom of the page, Schaffer et al 2006) (6/08)
• Revised the MoodCheck bipolar screening page to provide a bipolar tool only; for depression, the PHQ-9 is linked (6/2008)
• How long does it take for medication to go away when it is stopped?  The story of half-life (5/2008)
• Added a reference on the mechanism of lamotrigine antidepressant action to the lamotrigine page (5/2008)
• Added Wisconsin governor's website for medications from Canada, to the Internet resources page (5/2008)
• Added another recent study on fish oil (versus fluoxetine/Prozac, or combination: Jazaveri, 2008) to the Fish Oil table of studies; updated the reference on dose of fish oil in the Su study (5/2008)
• Revised the MoodCheck screening tool for simplicity (based on input from several primary care doc's); rewrote the directions accordingly (4/2008)
• Added two new updates with references to the Thyroid and Bipolar page (4/2008)
• Added a new reference to the fish-oil studies table, Su 2008, which shows strong evidence of benefit in depressed pregnant mothers (4/2008)
• Added a column to the Mood Stabilizers master list: agents for Bipolar Depression (4/2008)
• Added a summary of the 2008 diagnostic guidelines from the International Society for Bipolar Disorders, published last month (4/2008)
• Added an online source for the over-the-glasses model of the amber lenses, courtesy of Mr. W.A.;  and a way to find a local UVEX dealer, courtesy of Ms. T.S. (3/2008) 
• Revised the page on light therapy to include a new study suggesting that midday light may be better than morning light for people with bipolar depression (3/2008)
• Added quotes from two recent papers on antidepressants in bipolar patients, to the Antidepressant Controversies page, controversy #2 on mood destabilizing risks (3/2008)
• Reorganized the Antidepressant Controversies page, Controversy # 3; simplifying and clarifying the issue and the two relevant studies (3/2008) 
• Updated the True Hope page with a testimonial from a woman with a bad experience on it; bottom of the page (3/2008)
• Added a description of how to find $7 blue-blocking amber lenses for "virtual darkness" to the page on light and darkness in bipolar disorder (2/2008)
• Added lists of therapists and Corvallis, Eugene, and Portland who have special interest and experience in bipolar disorder diagnosis and management.  (2/2008)
• Revised the page on Weight Gain and Bipolar Disorder to include new data on metformin (2/2008)
• Added a reference on the effects of exercise on bipolar disorder to the general page on exercise. (1/2008)
• Revised the olanzapine (Zyprexa) page to include three studies on amantadine and metformin as antidote medications for weight gain; thanks to correspondent Henry for sending those and requesting the update. (1/2008)
• Referred primary care readers to the patient/family version of treatment,  per the next entry below, rather than continue to offer specific PCP-oriented revisions of the Treatment page. 
• Major revision to the Treatment page, adding my strong endorsement of lamotrigine now that I am no longer taking money from the manufacturer (1/2008)
• Revised the Funding page reflecting a change in funding from the lamotrigine manufacturer, as that medication is going generic this year (1/2008)
• (Missed an addition created back in 10/2007):  an extensive explanation of the basis for using high-dose thyroid hormone as a mood stabilizer. 
• Added a reference to research at the University of Alberta confirming that, even though research interest is growing, little is known about the relationship between women's reproductive hormones and mood disorders; to the Hormones and Mood page (12/2007)
• Added a new reference to the data on whether aripiprazole has antidepressant effects (11/2007)
• Updated the valproate guidelines page, to include a detail about switching from DR Depakote to ER Depakote: add 500 mg.(11/2007)
• quetiapine interaction with carbamazepine; update added to the quetiapine page (11/2007)
• Antidepressants and suicidal thinking: a biologic marker? (11/2007)
• Revised  the antidepressant controversy page to include the new STEP-BD study on switch rates (11/2007)
•  Added a new dawn simulator to the list of options (11/2007)
• Revised the antidepressant controversy page, simplifying, added one reference (11/2007)
• Weight gain on Zyprexa:  less with the wafer form? Another study says yes, just in. See the weight gain page update. (October 2007)
• Added another segment to the page on the biological clock and its role in the basis of bipolar disorder; a new study showing sleep deprivation increases activity in the amygdala (October 2007)
• A very brief history of the use of lithium in bipolar disorder (October 2007)
• Added new data on aripiprazole for treatment of depression to the page on atypical antipsychotics (October 2007)
• What causes bipolar disorder?  A summary of available information (September 2007)
• Evolution and cooperation and religion -- all together in one essay? (September 2007)
• Translation into non-medical English of an excellent summary on the risks of antidepressants and young people, added to the main page on the FDA warnings about antidepressants (September 2007)
• Minor revisions to the What Is an Antipsychotic? page, nothing major; updated the tardive dyskinesia reference link (June, 2007)
• Added a link to a review article which presents views identical to mine on both the patient and clinician's versions of the Diagnosis page (May 2007)
• Added PAR outlines for primary care physician's considering lamotrigine or quetiapine, to the Primary Care Providers Resource Center (May 2007)
• Added a "controversy zero" section to my list of antidepressant controversies, namely the question of whether antidepressants actually work at all in bipolar disorder (May 2007)
• Metformin, a medication to lower blood glucose and diabetes, was recently subjected to a randomized trial in patients taking olanzapine (Zyprexa), as an antidote to weight gain.  Unfortunately, it was not much more effective than a placebo.  Update and reference added to the page on managing weight gain (May 2007).
• Added a link to a very interesting article on pharmaceutical company sales representatives' techniques to my page on how this website is funded (May, 2007)
• Added a slide set for a Primary Care symposium for Student Health Center providers, from an invited presentation at Washington State University, Bellingham (May 2007)
• Updated the FDA warnings page to include their new advisory for manufacturers, suggesting that the warning about suicide potential be extended to include young adults between the ages of 18 and 24. (May 2007)
• Updated the Psychotherapy page with the new study from the STEP-BD program showing that three of the most well-recognized psychotherapies work better than treatment as usual in bipolar depression. (May, 2007) Note that these treatments produced a difference in a patient group very similar to that in which antidepressants produced no benefit greater than placebo, as in the update just below.
• Updated the Antidepressant Controversies page with the new study from the New England Journal of Medicine in which suggests that antidepressants have much less value in the treatment of bipolar depression that is generally thought (April 2007)
• Updated the page on mood treatments causing brain size increases,with a report from the UCLA showing that lithium treatment in bipolar disorder increases brain size in the cingulate gyrus, a region clearly associated with mood control.  (April 2007)
• Updated the page on metformin to include an article from November of last year (2006) showing a clear benefit (no further weight gain, but not loss). February 2007
• What causes weight gain from Zyprexa and other "atypical antipsychotics"? A new result brings us one large step closer to understanding this process and perhaps being able to devise a means of avoiding it. The article link and a brief explanation have been added to the Weight Gain page. (February 2007)
• Breast-feeding and Medications: added a couple of sites with master lists to the Useful Resources page.  (December 2006)
• On the Light Therapy page, the extended Safety discussion was updated with new information on the blue light box vs. the white ones; and with some links to a green-light system. November 2006). 
• On the Light Therapy page, the section on When to Use It was updated with new links to two different questionnaire systems, including a new one which produces a very sophisticated report on you and your timing plan. (October 2006)
• Updated the section on serotonin transporter gene type and response to antidepressants in bipolar disorder. Now that there's a lab test, as discussed in the entry just below, these data become more relevant. Yet still the bottom line is the same: knowing your gene pair (two shorts? two longs? one each?) won't help you decide whether to use an antidepressant. So there's still no point in getting the lab test for that reason. Maybe some other reason? See mini-chapter 5 on that. (October 2006)
• Added a section to the essay on whether to test yourself for your serotonin transporter gene type: there's a lab test available now. Oh brother, is this going to be messy, having the test before we know what to make of the results. The added paragraph starts here.  (October 2006)
• Updated the section on safety on the light therapy page to include a rather official statement that everything's fine, but also a reference to a group that thinks it's not that simple, in an expanded safety statement at the bottom of the page. (October 2006)
• Two new links from the Antidepressant Controversies page:  they're buried, don't go looking for them; but they're important: an Australian group reports antidepressants might have mood stabilizer effects in some patients with Bipolar II; and a well-known bipolar expert, Joe Goldberg, reviews the risks of antidepressants, presenting the same data and conclusions as outlined on my site. (September 2006)
• Added a link to my Letter to the Editor: Confessions of a Disease Monger to the Funding and Trust pages. (August 2006)
• Added a section to the borderline/bipolar page to include the perspective of Gunderson and colleagues, emphasizing somewhat more than previously the risk of calling "borderline" "bipolar" -- raised hopes. It's near the bottom of that page. (August 2006)
• Added a brief paragraph to the page on the Brain Chemistry of Maternal attachment, linking research on how environment can trump genes. (August 2006)
• Minor revisions, including new links to no-blue products, made to the light/darkness essay (August 2006)
• Free, online -- computer-based -- cognitive-behavioral therapy described and linked. (July 2006)
• Revised the Treatment Details page with two new book links for non-medication approaches (July 2006)
• New page on Light and Darkness in bipolar disorder mood problems -- and treatment (July 2006)
      With it, a page on how the biological clock works, and how lithium affects it (See Blog entry 7/9/06)
      And a page on blue light, which appears to be the key wavelength regulating the biological clock 
• Updated the short/long gene story to include new data on how these genes affect treatment. (June 2006)
• Updated Controversy 1 on the Antidepressant Controversies page. (see Blog entry 5/27)
• Updated the exercise page with a new reference (see Blog entry 5/26). 
• The Blog officially begins. (May 2006)
• Mixed states and rapid cycling explained as mood/energy/intellect cycling -- at different speeds; a translation of an important new model from Drs. Mackinnon and Pies.  This model really seems to help my patients understand these complex variations (April 2006). 
• Small new section on nimodipine added to the calcium-channel blocker page. (April 2006)
• Added a new testimonial section to the fish scraps page: these are people whose response seems unique in a way that makes a placebo response less likely. (April 2006)
• Revised the fish oil page for clarity, and to add a 2-pills-per-day version that's not too much more expensive than the cheapest one. (March 2006)
• Another update to the PCOS and Depakote page, this time a much larger study (than a month ago): these appear to be the most definitive data yet, to my eye. (Feb 2006)
• As dramatic a "breakthrough" as the bipolar story may ever yield was just published.  I'll write this up soon from a more basic starting place; meanwhile, here's one version of this story about lithium and biological clock regulation (GSK3B and rev-erb). (Feb 2006)
• Link to a review of internet-based therapies from Jan 2006 added to my "Find a Therapist" essay; you must be signed up with Medscape (free) to read. (Feb/2006)
• Updated the quetiapine (Seroquel) page with a brief note about a probable medication interaction -- not dangerous, just a significant blood level shift upward, probably allowing lower dosing -- with valproate (Feb 2006). 
• Brief update added on the TrueHope nutritional supplement page: the product has received a license from the Canadian government, and their website indicates that research is still underway (no details there). (Feb 2006)
• Added a brief summary of main points to the beginning of the BP II diagnosis section -- and a very funny cartoon to go with. (Jan 2006)
• Added a 32-item checklist of hypomanic/manic symptoms recently published by a well-know European team, called the HCL-32. A symptom-list-only version in pdf might be useful to some clinicians performing bipolar screening. (Jan 2006)
• A small but interesting update to the lamotrigine page: a 3-case report of lamotrigine associated with manic symptoms (after very rapid dose increase), strengthening my concern that it can occasionally actually worsen mood stability. (Jan 2006)
• Added another recent study, Frangou and colleagues,  to the fish oil table (the one which presents the studies of omega-3 fatty acids and mood). This one may be one of the strongest yet -- particularly because it focuses on bipolar depression. (Jan 2006)
• Updated the PCOS and Depakote page with data from the first study to follow women over time, watching their hormone levels while taking Depakote or other mood stabilizers (a "longitudinal" study; small, but a start). (Jan 2006)
• Updated the lithium risks review with some further thoughts from the UCLA group from their 1999 review. (Jan 2006)
• For people who want to see some details on Lithium Risks, here's a new page on thyroid, kidney and weight gain problems, based on a recent review by a couple of British doctors. (December 2005)
• Revised the "what causes bipolar disorder" section to reflect our continued lack of a good overall theory; the evolutionary perspective on what mood disorders are; and a recent article on brain scanning during mania, showing a lack of activation of the frontal lobe areas associated with being able to hold back on an impulsive action. (December 2005)
• Updated the connection between stress hormones and depression with a small bit of new data from Emory University on corticotropin-releasing hormone (CRF) and how its two different receptors, CRF1 and CRF2, may explain how stress hormones can be good guys and bad guys under different circumstances. (December 2005)
•  Updated the topiramate page with a new study of topiramate in the treatment of Bipolar I mania. What's interesting here is patients randomly assigned to topiramate + risperidone did as well in this 6 week trial as those on valproate (Depakote) + risperidone, yet did not gain weight (half lost a little) while those in the valproate group gained a pound a week on average.  (December 2005)
• What happened in November? Nothing new? Attentions were elsewhere: I was working with the publishing company McGraw Hill putting finishing touches on my book version of this website, which is on schedule to be released in early March. Roughly the same stuff but better organized, and expanded to the point where it is (hopefully) easier to read from a book than a computer screen. 
• Updated the Mood Stabilizer "menu" I use with patients (added Seroquel to main options box; a few more details on Geodon and aripiprazole; removed a few from research list; moved fish oil to "add-on's" list from research list). This one-page handout is accessed from the Primary Care Providers' page. (October 2005)
• A new page summarizes my philosophy regarding antidepressants: use one of the eight approaches which aren't antidepressants! (October 2005)
• The doctor's version of bipolar disorder Treatment (start here to navigate there), which is still a very trimmed-down version compared to the patient version, was updated in several places and now matches the patient version better.  (October 2005)
• The Funding page has been updated with the latest on whose money I'm using to run this site and why I think I'm still not too biased (with a hint on where to look to decide that for yourself). (October 2005)
• On PCOS and Depakote page: Added a September 2005 study which adds one small further bit of evidence supporting this connection. There are no new clearly opposing data I've come across in the last few months. (October 2005)
• Updated the Light Therapy page in light of a new study showing that a rigorous review of the evidence makes this treatment look even more effective than generally thought, even perhaps for non-seasonal depression. (September 2005)
• Added a new page on Dawn Simulators when I couldn't find a good page on the internet about them. It summarizes models available, cost, and how to use them. (September 2005)
• An essay on Evolution. Why? Because it's the model I use all the time. And because without it, much of the science on this site wouldn't hold together. So if what you read here makes sense, you might need to have a look at the evolution idea again. (September 2005)
• Updated the Antidepressant Continuation page with details from the first randomized study on this issue by Ghaemi and colleagues; and links to another non-randomized report recently published. (August 2005)
• A description of how to change variables has been added to the mood charts page. (August 2005)
• Minor update to the page about the Gijsman meta-analysis of antidepressant switch rates, noting letters to the editor about their article which just appeared; and linking the Balance II study, which will help with this controversy. (August 2005)
• Does lamotrigine lower the effectiveness of birth control pills?  Looks like the answer is a cautious no, in my opinion, but here's everything I can find on lamotrigine and oral contraceptives. (August 2005)
• The Treatment section of the main bipolar webpages has been revised for clarity and to match the TMAP emphasis below. (July 2005)
• The Texas Medical Algorithms Project (TMAP) has updated their guidelines for treatment, especially of bipolar depression. The changes from their 2000 version are summarized; linked from the Expert Guidelines page. (July 2005)
• The menopause page has been updated with a link to a nifty CDC workbook for evaluating hormone therapy risks and benefits; and with a page on estrogen basics as they apply presently in Psychiatry, including a possible relationship to increased anxiety if the level is too high. (July 2005) 
• Updated the Seroquel page with a new small "open trial", but long term, of Seroquel added to other medications. (July 2005) 
• Chapter 4 in the Brain Chemistry of Depression section: a revision is now complete, with some stunning new data from the NIMH connecting the genetic vulnerability to depression with the genetic vulnerability to anxiety. (July 2005) 
• A brief explanation of functional Magnetic Resonance imaging (fMRI) (July 2005)
• The FDA issued a new warning about suicidality and antidepressant use in adults in late June 2005; this information is incorporated in a revised introduction to the FDA warnings essay. (July 2005)
• At a reader's suggestion, I've finally gotten around to adding a search engine for the site, courtesy of Google's free service. (June 2005)
• John Gartner's book The Hypomanic Edge, and his website, are linked in an informal review attached to the Diagnosis Details page. (June 2005)
• A warning about the diagnosis of bipolar disorder in children, to temper the enthusiasm of the BPKids site, was sent by Dr. Sobo at my invitation and added as a link to the Diagnosis Details page. (June 2005)
• A third "warning" was added to the page introducing the serotonin transport gene differences and their role in the causation of depression, also from Dr. Sobo, with a brief story and links to his essay on Chemical Imbalances (versus understanding patients' lives). (June 2005) 
• An opposing view regarding use of antidepressants in Bipolar II, from Dr. Simon Sobo, has been added to the antidepressant controversies page, with links to his essays on bipolar diagnosis. (June 2005) 
• The Weight Gain with Treatment page: updated with two references: amantadine minimally effective in a randomized trial; and the new Zyprexa Zydis approach (not a randomized trial, but at least some comparison to go by on this new idea). (June 2005)
• A new diagnostic approach based on "scoring" bipolar symptoms and other signs of bipolarity has been published by Dr. Gary Sachs, describing the system now in use at Harvard. A new page describing their system has been linked to the main Diagnosis pages. (June 2005)
• Updated the "Bipolar Hypothesis" re: FDA warnings of suicidal thinking following antidepressants with two articles that make the same case. (June 2005)
• Minor additions to the Fish Oil pages: Fish burps with omega-3's reduced by freezer storage, some say; and no PCB's found in 5 different capsule types (May 2005) 
• Medscape did a great interview with Gary Sachs, the head of the Harvard Bipolar Clinic: here is a link and a few excerpts. (May 2005)
• Added a nifty drug-interaction website to the Select Sites page. (May 2005)
• Rewrote the lithium information page (section on long-term risks) in response to input from Ms. H' on kidney risk. (May 2005)
• Added a brief comment and link to a British Medical Journal issue which looks and and warns about pharmaceutical industry funding. (May 2005)
• Some very minor revisions in the "How do I choose?" section of the mood stabilizer page, basically just downgrading Trileptal another notch. (April 2005)
• Like other effective antidepressants, exercise also can reverse brain atrophy, according to one small study. (March 2005)
• Added a new data from a small but randomized, controlled trial to the "dark therapy" page, showing it adds to treatment as usual for hospitalized patients with mania.  This really helps strengthen the idea of adding this as routine "treatment". (Feb 2005)
• Added a brief note with a link to two studies which try to put numbers on antidepressant risk in kids (Feb 2005)
• A few more references on bipolar versus borderline personality diagnoses, courtesy of a helpful correspondent sending good links, now appear in the first paragraph of that essay. (Feb 2005)
• Brain Chemistry of Depression section finally completed (Feb 2005).
• The 1983 reference for the seemingly radical idea that there are predictors of bipolarity besides hypomania was linked to the doctors' version of the diagnosis page re: BPII.  You got that date right:  1983.  The idea sounds radical, but is not new. (Jan 2005)
• Added one more reference on Depakote and PCOS, and revised my opinion accordingly: the debate is looking nearly over, in my view. (Jan 2005)
• A revised Expert Guidelines page includes the December 2004 update of the Expert Consensus Guidelines series, including a new version of their excellent beginner's guide for patient and families. (Jan 2005)
• Revised my Funding page to reflect larger sums received for speaking events, and how that money is used for "cost shifting" -- or is this a rationalization? (Jan 2005)
• Chapters 5, 6 and 8 now complete in the new section on Depression (maroon below). (December 2004)
• Revised the patient and doctor sections on Diagnosis of bipolar disorder to include "soft signs". (December 2004)
• Three more chapters of the new section immediately below have been completed.  (December 2004). 
• Depression is Not a Moral Weakness; It Has a Biological Basis; and Here Are the Pictures to Prove It. 
  A major update of the section on stress and depression, this revision includes a much broader range of information about what causes depression.  There are about 10 little "chapters".  Three are complete now; the rest will appear one by one through December.  I'll post another notice when the whole set is done. (November 2004)
• Revised the electronic mood chart section to include additional charts with more medications and room to chart additional variables. (November 2004)
• The recent prominent article by Gijsman and colleagues implies we've had it wrong about the risk of antidepressants causing "switching" from depression to mania, but the article is not what it says it is in the abstract. (October 2004)
• A small addition to Antidepressant Controversies acknowledges a recent set of articles about whether antidepressants really cause rapid cycling; see Controversy 2a.  (Oct. 2004)
• A brief essay on What is a Mood Stabilizer? links a new article by Bauer and Mitchner, technically rather interesting, and very rigorous in definitions. (Oct. 2004)
• Electronic Mood Charting:  if you use a computer nearly every day, this might be a better way to chart long-term, and it will automatically generate a graph of your mood course, sleep, and medications. (October 2004)
• Unipolar and bipolar disorder are one thing that we've artificially split into two, says a recent prominent 2004 article. This is just the important data-graph, with interpretation.  (September 2004)
• The Treatment section of the Bipolar II material, and the Antidepressant Controversies page, have been rewritten to reflect new reviews by Dr. Ghaemi and others.  (September 2004)
• New page on quetiapine (Seroquel) for the mood stabilizer list, based on new data showing antidepressant effects. (Sept 2004)
• Linked the descriptions by Dr. Arnold Lieber of "bipolar spectrum" symptoms -- he sounds like me (but in technical lingo). This is from Dr. Ivan's site; from this page. 
• A "Primer" for use of lithium in primary care treatment of depression, as suggested in the TMAP algorithm, was added to the Primary Care Providers' Resource Center; with thanks to Dr. Bauer for the slides.  (August 2004)
• Added links to the TMAP depression algorithm and a British counterpart on the main page of the Primary Care Providers' Resource Center. (August 2004)
• Revised the essay on ADHD "versus" bipolar disorder in kids, to include a more graphic version of the ways to tell them apart.  (August 2004)
• A brief essay introducing a NYTimes article on the biology of the connection between mother and child -- the brain chemistry of parental attachment. (August 2004)
• Added a slide showing variation in TSH over 24 hours, which suggests drawing blood for TSH only during daylight hours (July 2004)
• Updated the Resource list in the essay on Menopause and Mood to include a list of specialists in this area from a Canadian listing, A Friend Indeed.  
• Added a section on valproate to the essay on Lab Testing for Safety (July 2004)
• Revised the Depression -- Inside Cells page to include new data on BDNF (June 2004)
• Revised the downloadable MDQ per user feedback, adding "blood" relatives in the family history screen; adding "while not on alcohol or drugs" to question #1; and restoring the original question 3 in light of the Isometsa data (had been simplified to yes/no in previous revision of the "Primary Care" MDQ). (June 2004)
• Added a page describing the concerns of Zimmerman et al regarding the validity of the MDQ self-report test for bipolar disorder; pretty technical discussion. (June 2004)
• Found a new source for the MAP manual for treatment of panic disorder without medications, hallelujah.  See the link from the home page, bottom left. (June 2004)
• Using the MDQ in primary care: positive and negative predictive value of MDQ results (May 2004)
• How often to do lab tests in someone on carbamazepine?  There is no clear consensus, based on what experts actually do.  Added a transcript of such a conversation, and conclusion; linked from the carbamazepine page.  (May 2004) 
• Risks and Reasoning is an essay about why patient's reports should not be dismissed as "testimonials" when it comes to identifying risks (as opposed to identifying treatments that work) (April 2004)
• Revised the "Mood Disorders Questionnaire" for use by primary care doctors to include all required questions and warnings per the 2004 FDA ruling.  (April 2004)
• Summarized and linked the 2004 Consensus Statement from the American Diabetic Association (and others) regarding Zyprexa risk as it should be presented by primary care doctors. (April 2004)
• Linked an interesting summary/review of the TrueHope controversy (EMPowerplus nutrient treatment) on the TrueHope page. (April 2004)
• Added links to a very thorough website about bipolar disorder diagnosis and treatment by Dr. Peter Brigham, just rediscovered at its new location. (April 2004)
• Summary of case reports about suicidality induced by antidepressants, presented to the FDA, from FDA transcripts; and an explanation of why they're possibly so important (April 2004)
• The Antidepressant Controversy page was revised again to include a link to a new page:   A summary of the FDA Warnings.  (March 2004)
• The Antidepressant Controversy page has been revised to include reference to articles in a special issue of Bipolar Disorder (December 2003) which comment directly on these issues.  See the perspectives of Nassir Ghaemi at Harvard, and Joe Goldberg at Cornell.  (March 2004). 
• Updated the Metabolic Syndrome and Mood page with a link to a note about Atkins dieting and mood effects (Jan 2004)
• Added a sample of the thyroid (T4 or T3/T4) debate, and the recent randomized trial on that issue (Study 5), to the page on thyroid studies. (Jan 2004)
• Revised the treatment sections, putting basics in one place (Treatment page) and details on the mood stabilizer page.  Noted the recent study on MRI-magnetic fields decreasing depression.^Rohan (Jan 2004)
• Added some incredible image links, showing the brain in action, to the Science and Mind page (Jan 2004)
• Rewrote the bipolar Treatment section to include a new graphic on deciding between mood stabilizers (Dec. 2003)
• Brief analysis of another "negative" fish oil study, added to the table of studies on the fish oil page (Dec. 2003)
• Rewrote the mood stabilizer list page including new tables on choosing between medications (Dec 2003)
• An article, "untranslated" as yet, about how cyclic changes in estrogen affect female (rats) susceptibility to stress (Dec. 2003) 
• Fish (oil) stories: more details on fish oil treatment.  (Dec 2003)
• Fish oil as a treatment for depression in pregnancy; a case report.  (Dec 2003)
• Added a review of a recent article on antidepressant maintenance in bipolar disorder by Dr. Altshuler and colleagues, to the page on the "antidepressant controversy". (Nov 2003)
• Revised the aripiprazole and oxcarbazepine pages slightly (Nov 2003)
• Added a 19-patient case series report to the TrueHope page (Nov 2003)
• Minor addition to the antidepressant controversy page (Nov 2003)
• Revised the Omega-3 fatty acids page to include an summarize several new studies (Oct 2003)
• Added notes on 4 medications to the mood stabilizer table (tiagabine, zonisamide, aripiprazole; and 2nd generation antipsychotics generally) (Oct 2003)
• Updated essay on borderline and bipolar with new case report of thyroid abnormalities in "borderline" (August 2003)
• Amantadine for Zyprexa weight gain (see weight gain management generally) (August 2003)
• Psychotherapy for bipolar disorder: five methods, all with evidence they work (August 2003)
• Very exciting new research results from Dr. Kelsoe's group on GRK3 and CRF, a major possible advance in understanding the genetic and molecular basis of some kinds of bipolar disorder (August 2003)
• revised the lamotrigine page with new references and a page on dealing with rashes (July 2003)
• Completely revised bipolar disorder treatment pages for doctors and patients (July 2003) (start here)
• Added Dr. Altshuler's new article on antidepressant continuation to treatment pages (July 2003)
• Revised page on "Is there something wrong with TrueHope?" (July/2003)
• About the big bucks that doctors, including me now and then, get for presentations, from drug companies (May 2003)
• Exercise and Mood: not the usual rap (completed August 2003)
• revised the page on topiramate (Apr/2003)
• revised omega-3 fatty acids page to include new data (Apr/2003)
• (there was a little pause in early 2003 while I worked on opening a private practice)
• revised the section on TrueHope.com, the nutritional supplement, to reflect new concerns (Jan 2003)
• Menopause and Bipolar Disorder; what if both are present? (Dec 2002)
• Revising menopause/hormone treatment/risk assessment sections (to continue through Dec 2002)
• Weight gain and Bipolar Treatment (Dec 2002)
• Bipolar Spectrum Diagnostic Scale (BSDS): scale, scoring, sensitivity (Dec 2002)
• "metabolic syndrome" : another cause of mood instability? this topic needs to be understood by anyone under treatment for bipolar disorder (Oct 2002)
• metformin (Glucophage): my guidelines for patients on its use, usually to treat "metabolic syndrome" (Oct 2002)
• What's the difference, if any, between metabolic syndrome and PCOS? (Oct 2002)
• APA Practice Guidelines for the Treatment of Bipolar Disorder: guided tour of revised guidelines (Aug 2002)
• Anxiety and Bipolar Disorder -- an essay on the relationship between these conditions (part of? separate? effect on treatment options?) (July 2002)
• Connected the Brain Tour section on Fear to a great site by Dr. LeDoux, a lead researcher in this area (July 2002)
• Added a link to a site on PTSD in the Fear section(July 2002)
• A new Table listing all mood stabilizers in one place (June 2002)

P.S.: This list of updates and revisions was begun June 2002.  The site was originally written in 2001, with some unrecorded changes in between.