La diferencia entre literatura y periodismo es que el periodismo es ilegible y la literatura no es leída

Francisco de Goya y Lucientes, El Aquelarre, 1797.

The scientific evidence fails to distinguish unipolar and bipolar depressive disorders. About 10% of melancholic patients exhibit manic features. The overlap is clearly expressed in the many descriptions of ‘‘mixed’’ and ‘‘spectrum’’ depressive and manic conditions. Patients may exhibit depressive and manic features during the same episode or episodes may recur in cycles, changing from one to another within weeks, days, or even within hours. The depressive state that is identified in a patient with a history of a manic or hypomanic episode cannot be distinguished from the depressive state in a patient without such a history. Neither family history nor course of illness successfully separates the two conditions. Nor does the putative induction of mania by antidepressant drugs assure the separation as the incidence of manic switches is no greater than the natural switch rate; it is sufficiently uncommon as not to be useful as a diagnostic test.

The responses to lithium and to anticonvulsants are cited as justifications for bipolarity. To support such a view, the evidence of the antidepressant efficacy of lithium is minimized, and the control of manic episodes by anticonvulsants maximized. Lithium is both an eVective antidepressant, especially in maintenance therapy, and an effective control for mania. Anticonvulsants are weak mood stabilizers; the treatment algorithms commonly require the polypharmacy of mood stabilizers (often two), antipsychotic, and sedative agents. Yet patients in both the depressive and manic phases of the illness respond rapidly to electroconvulsive therapy (ECT). The neuroendocrine and sleep laboratory tests that demarcate severe depressive mood disorders from other psychiatric disorders are abnormal during both the manic and depressive phases of their illness. The degree of abnormality is apparently less for patients in the manic phases but the difference is not sufficient to support the concept of bipolarity.

Bipolarity as a separate psychiatric disorder is not supported by psychopathology, family studies, laboratory tests, or treatment response. A single disorder of melancholia circumscribes the present knowledge and offers a better model for continuing scientific efforts.