Treatment of rapid-cycling bipolar disorder
by
Schneck CD.
Department of Psychiatry,
University of Colorado Health Sciences Center,
Denver, CO 80220, USA.
Christopher.Schneck@uchsc.edu
J Clin Psychiatry. 2006;67 Suppl 11:22-7.

ABSTRACT

Rapid-cycling bipolar disorder is associated with poorer treatment response, poorer long-term prognosis, and probable higher suicide risk than bipolar disorder without rapid cycling. Patients with rapid cycling tend to experience more depressive than manic episodes, and the depressive episodes tend to be more refractory in nature compared with those in patients without rapid cycling. Results from studies of rapid cycling show that antidepressant use is most likely associated with the onset or worsening of rapid cycling. Controversy also exists as to whether rapid cycling is a transitory phenomenon in the course of bipolar illness or a more chronic condition better characterized as a subtype of the illness. Results from the first 500 patients with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study found an association between rapid cycling and depression and younger age at illness onset. Treatment involves a 3-part pathway to manage rapid cycling that includes reducing or stopping any possible cycle-promoting agents, adding or optimizing mood stabilizers, and using experimental or putative treatments for persistent rapid cycling after more traditional treatments have failed. Effective treatments for some patients with rapid-cycling bipolar disorder currently include lithium, divalproex, lamotrigine, carbamazepine, atypical antipsychotics, and psychosocial therapy.

Mania
Lithium
Bipolar II
Valproate
Clozapine
Gabapentin
Lamotrigine
Unipolar mania
Protein kinase C
Bipolar disorders
Drugs for bipolars
Lithium prophylaxis
The manic spectrum
Schizoaffective disorder
The many faces of mania
Genius and psychopathology
Mania: lithium versus divaplroex
Dysthymia, hyperthymia and cyclothymia
Manic thinking, happiness and depression

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