There is pressure. To this jobbing psychiatrist, Bipolar II and adolescent Bipolar don’t exist. Kraepilin had described the phenonema in his monograph manic depressive psychosis. But then, I do not consider DSM 5 an authority, but a series of best guesses.

Nowadays, most Big Pharma marketing is indirect – and via control of the medical research literature, especially randomised controlled trials- also by management of meetings, consensus and guidelines.

But I think we currently have the worst of both worlds – licensing does not prevent gross abuses (such as multi-drug cocktails of all-known psychiatric drug classes for so-called Bipolar II disorder diagnosed in about 1/20 people; or the use of antipsychotics in children and immature adolescents) — but licensing is (rhetorically) used to make doctors unconfident and indeed afraid about using old, cheaper and safer drugs for indications licensed for new/ expensive/ on-patent drugs.