I will focus on several areas of differences in nuance of interpretation of the data and in emphasis regarding the general clinical treatment paradigm suggested by Parker. As he notes, the entire field of bipolar research suffers from a paucity of systematic studies in the literature, thus opening the issue of optimal treatment approaches to a great diversity of opinion.

However, one notable difference in tactics that I would employ is to emphasise that BP II depression is similar to recurrent unipolar depression, but that recurrent depressive illness – of either the unipolar or bipolar variety – carries rather grave risks to one's psychological and medical health. The risk of suicide is high in both syndromes, and in some studies, even higher for BP II than for BP I illness (Rihmer and Pestality, 1999). Recurrence and disability rates are serious and the medical risks are substantial. For example, those who are clinically depressed are two- to four-times more likely to suffer from a myocardial infarction, and if they are depressed at the time of the heart attack, they are two- to four-times more likely to die, than those who are not depressed (Jiang et al., 2002; Malach and Imperato, 2004). Such increased medical risks for illness onset and poorer prognosis when in company with depression cut across a great variety of medical illnesses, from diabetes to complex pain syndromes.