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The pharmaceutical industry in this country is sophisticated and canny. Drugs are advertised directly to consumers, doctors are wooed with gifts and gourmet dinners, and biased product information is provided to physicians along with generous samples. A physician (or patient, for that matter) has to go out of their way to find nonbiased information.

My husband recently dragged me to a drug company sponsored dinner - we are both physicians. I hate these dinners, but he likes the fancy food and the opportunity to socialize with his colleagues. The drug was Seroquel, developed as an atypical antipsychotic for treatment of thought disorders like paranoia and hallucinations. It is no more effective as an antipsychotic than the older medications, like Haldol and Thorazine, but it appears not to be as likely to cause permanent movement disorder. It causes other problems, however, like weight gain, which causes an altogether different set of issues, especially for patients with medical problems like diabetes, hypertension, or heart failure.

Now my gripe isn't so much about the use of Seroquel for psychosis; I prescribe it often enough myself for selected patients. But this drug company dinner was touting Seroquel for use in bipolar disorder. This disorder is known to many as manic-depression, where a person's mood swings from extremes of depression to mania or hypomania (a milder version of mania). To diagnose someone as this disorder, one needs to document more than just mood swings. The depression would be severe, recurrent, and would last at least a week. The mania is characterized by a week or more of expansive mood, increased self esteem, hypersexuality, increased energy, markedly decreased sleep, and other criteria. Obviously, it is important to the well being of the patient with bipolar disorder that their symptoms be stabilized so their mood is predictable and even.

The drug company was touting Seroquel as being equal to other medications for management of bipolar disorder. The doctors in the audience were excited about the results they had achieved using Seroquel for bipolar disorder. Many of the providers there were from the local Community Mental Health agency. Their agency, like most in this state and around the country, are hurting for funds to maintain their services to the poor and uninsured.

The traditional treatment for bipolar disorder is lithium. While many other medications, usually anticonvulsants, are also used for bipolar disorder, none has been

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