- In 2001, the ITAKA Foundation organised a campaign under the slogan "Cure depression!". I would like to ask you not whether depression can be cured, but whether it can be cured.
- It is certainly possible to cure an episode of depression. As affective disorders have a recurrent course, it is also important to prevent recurrence of depression and, in the case of bipolar disorders, also of mania. In people with frequent relapses, prophylactic, mainly pharmacological, management is therefore used.

- Prophylaxis?
- The problem of effective pharmacological prophylaxis is that long-term treatment requires the cooperation of the patient and the doctor. If the bipolar disorder started with an episode of hypomania and the patient has not suffered any distress because of it, it is difficult for him to understand that he is in a high-risk group and should be pharmacologically protected on a continuous basis. In contrast, people with frequent relapses that have significantly complicated their lives are more likely to be presented with the opportunity offered by pharmacological prophylaxis and to cooperate in its management.

- In the psychiatric community, it has become very "trendy" for some time to prescribe so-called mood stabilisers.
- But please don't use that term! What do you call neuroleptics? Terminators of psychosis? And antidepressants are what? Mood elevators? And anti-anxiety drugs? Anxiety eliminators, yes? These "mood stabilisers" are normothymic drugs....

- ...from the anti-epileptic group, if I'm not mistaken.
- The first normotimic drug was lithium. It has been used in the treatment of mania since 1949 and its normotimic properties were discovered in the 1960s. In our Clinic we administered it to patients for the first time in 1971. Clinical experience confirms its prophylactic properties. One third of patients on long-term lithium treatment do not relapse at all.

- This is not an impressive result. Especially if one looks at the index of adverse effects of lithium.
- In recent decades, antiepileptic drugs, initially carbamazepine and valproate, and more recently lamotrigine, have joined the normothymic drugs. Personally, however, I believe that lithium - with all the caveats - is still one of the leading drugs in prophylactic action. Of course, it cannot be used in cases where the patient cannot tolerate it well or where there are clear medical contraindications.

- Forgive me, Professor, but with all due respect for the progress of medical science, I have the impression that psychiatry has a pharmacology more on the scale of an elephant than a human being. There is no guarantee of positive effects, at most an order of respectability. The likelihood of drug-related health complications, on the other hand, is almost certain.
- I do not believe that psychopharmacology should feel inferior to pharmacological treatment in other areas of medicine. No one has yet invented a drug that is completely free of side-effects. We know more about traditional medicines. We can 'call out' more precisely what they harm and to what extent they help. Progress in pharmacology is, as we all know, not error-free, but this does not mean that we should stop looking for drugs that are more effective and kinder to our bodies. Nor does it mean that we should stop using proven drugs just because new ones have appeared. Optimisation of the treatment of depression, especially in cases of episodes of severe depression, is still not always appropriate - this is a fact. Moreover, the therapeutic effect in the treatment of depression occurs with a delay of several weeks, which in this particular illness is of considerable significance for the patient. This in turn sometimes provokes too rapid a change of medication. Such actions not infrequently result in drug-resistant depression. However, I think that changes in social attitudes to this illness, educational campaigns, increased interest not only among psychiatrists, but among doctors in general, all this leads us in the right direction.

- In the ranking of "Wprost", your Clinic took second place when it comes to bipolar disorder. Is this a success or failure, Professor?
- In 2002, we took first place in the "Nesweek" ranking for the best psychiatry clinic in Poland. It is not without influence on the ranking that the criteria by which the assessment is made are selected. As for our centre and its participation in research on the pathogenesis and treatment of bipolar disorder, in addition to its importance in Poland, we are also active internationally.

- I have in front of me an American medical journal with an international character and reach - 'Bipolar Disorders'. You are the only Central European representative on its Editorial Committee. I think this is a great distinction for Polish psychiatry?
- I would like it to be so. The Editorial Committee of 'Bipolar Disorders' includes professors from Argentina, Brazil, New Zealand, Israel, Australia, Canada and, of course, the United States. As you can see from this, bipolar disorders afflict people in every latitude.

- The best in a particular speciality used to form their 'schools'. Can we talk about Rybakowski's 'school' in the treatment of bipolar disorder?
- No speciality in medicine is practised today as a 'school'. The best centres act in accordance with the achievements of world science in a given field. They apply the latest therapeutic standards, trying on the one hand to make their own contribution to them, and on the other to promote these standards at various conferences, training courses and so on.

- You are the supervisor of many doctoral theses on depression and bipolar disorders. This IS, however, Professor, a "school".
Thank you for the interview.

Interviewed by: Julitta Glęmbocka