Skip to main content
SpringerLink
Log in

Current concepts in rapid cycling bipolar disorder

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

The rapid-cycling variant of bipolar disorder (RCBD) has been variably defined, with episode frequencies ranging from several per day to a minimum of four per year. It is diagnosed disproportionately in women with bipolar II disorder. Its time of onset may be in childhood, adolescence, or adulthood. It appears to be treatment refractory, but controlled trials are lacking. Concurrent treatment with lithium and an antiepileptic drug is considered the current mainstay of treatment, and antidepressants are discouraged. Controlled trials in homogenous cohorts of RCBD patients are needed. Preliminary data suggest that two or more mood stabilizers are required for adequate control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kraepelin E:Psychiatrie III, Klinische Psychiatrie II. Leipzig: Verlag von Johann Ambrosius Barth; 1913.

    Google Scholar 

  2. Dunner D, Feive R: Clinical problems in lithium prophylaxis failure. Arch Gen Psychiatry 1974, 20:229–233.

    Google Scholar 

  3. Bauer MS, Calabrese JR, Dunner DL, et al.: Multi-site data reanalysis: validity of rapid cycling as a course modifier for bipolar disorder in DSM-IV. Am J Psychiatry 1994, 151:506–515.

    PubMed  CAS  Google Scholar 

  4. Maj M, Pirozzi R, Formicola A, Totorella A: Reliability and validity of four alternative definitions of rapid-cycling bipolar disorder. Am J Psychiatry 1999, 156:1421–1424.

    PubMed  CAS  Google Scholar 

  5. Coryell W, Endicott J, Keller M: Rapidly cycling affective disorder: demographics, diagnosis, family history, and course. Arch Gen Psychiatry 1992, 49:126–131.

    PubMed  CAS  Google Scholar 

  6. Kramlinger K, and Post R: Ultra-rapid and ultradian cycling in bipolar affective illness. Br J Psychiatry 1996, 168:314–323.

    Article  PubMed  CAS  Google Scholar 

  7. Kukopulos A, Reginaldi D, Laddomada P, et al.: Course of the manic depressive cycle and changes caused by treatment. Pharmacopsychiatry 1980, 13:156–167.

    CAS  Google Scholar 

  8. Tondo L, and Baldessarini R: Rapid cycling in women and men with bipolar manic-depressive disorders. Am J Psychiatry 1998, 155:1434–1436.

    PubMed  CAS  Google Scholar 

  9. Weissman M, Leaf P, Tischler G, et al.: Affective disorders in five United States communities. Psychol Med 1988, 18:141–153.

    Article  PubMed  CAS  Google Scholar 

  10. Price W, and DiMarzio L: Premenstrual tension syndrome in rapid-cycling bipolar disorder. J Clin Psychiatry 1986, 47:415–417.

    PubMed  CAS  Google Scholar 

  11. WehrT: Causes and treatments of rapid-cycling affective disorder. InPharmacotherapy of Depression: Applications for the Outpatient Practitioner. Edited byAmsterdamJ. New York: Marcel Dekker; 1990:401–426.

    Google Scholar 

  12. Leibenluft E, Ashman S, Feldman-Naim S, Yonkers K: Lack of relationship between menstrual cycle phase and mood in a sample of women with rapid cycling bipolar disorder. Biol Psychiatry 1999, 46:577–580.

    Article  PubMed  CAS  Google Scholar 

  13. Post RM, Kramlinger KG, Joffe RT, et al.: Rapid cycling bipolar affective disorder: lack of relation to hypothyroidism. Psychiatry Res 1997, 72:1–7.

    Article  PubMed  CAS  Google Scholar 

  14. Regier D, Farmer M, Rae DD, et al.: Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990, 264:2511–2518.

    Article  PubMed  CAS  Google Scholar 

  15. Haywood T, Kravitz H, Grossman L, et al.: Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry 1995, 152:856–861.

    PubMed  CAS  Google Scholar 

  16. Sonne S, Brady K, Morton W: Substance abuse and bipolar affective disorder. J Nerv Ment Dis 1994, 182:349–352.

    Article  PubMed  CAS  Google Scholar 

  17. Brady K, Casto S, Lydiard R, et al.: Substance abuse in an inpatient psychiatric sample. Am J Drug Alcohol Abuse 1991, 17:389–397.

    PubMed  CAS  Google Scholar 

  18. Puig-AntichJ: Affective disorders in childhood, a review and perspective. Psychiatric Clin North America 1980, 3:403–423.

    Google Scholar 

  19. Weller R, Weller E, Tucker S, Fristad M: Mania in prepubertal children: has it been underdiagnosed? J Affect Disord 1986, 11:151–154.

    Article  PubMed  CAS  Google Scholar 

  20. Geller B, Sun K, Zimerman B, et al.: Complex and rapid-cycling in bipolar children and adolescents: a preliminary study. J Affect Disord 1995, 34:259–268.

    Article  PubMed  CAS  Google Scholar 

  21. Maj M, Pirozzi R, Magliano L, Bartoli L: Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. Am J Psychiatry 1998, 155:30–35. This study provides evidence suggesting that lithium in monotherapy or in combination therapy is largely unhelpful in maintenance treatment of RCBD.

    PubMed  CAS  Google Scholar 

  22. Tondo L, Baldessarini R, Hennen J, Floris G: Lithium maintenance treatment of depression and mania in Bipolar I and Bipolar II disorders. Am J Psychiatry, 1998, 155:638–645.

    PubMed  CAS  Google Scholar 

  23. Calabrese J, Bowden C, Woyshville M: Lithium and anticonvulsants in the treatment of bipolar disorder. InPsychopharmacology: The Third Generation of Progress. Edited by BloomE and Kupfer D. New York: Raven Press; 1995:1099–1112.

    Google Scholar 

  24. Calabrese J, Woyshville M, Kimmel S, Rapport D: Predictors of valproate response in bipolar rapid cycling. J Clin Psychopharmacology 1993, 13:280–283.

    Article  CAS  Google Scholar 

  25. Post R, Uhde T, Roy-Byrne R, Joffe R: Correlates of antimanic response to carbamazepine. Psychiatry Res 1987, 21:71–83.

    Article  PubMed  CAS  Google Scholar 

  26. Denikoff K, Smith-Jackson E, Disney E, et al.: Comparative prophylactic efficiency of lithium, carbamazepine, and the combination in bipolar disorder. J Clin Psychiatry 1997, 58:470–478. This is the only prospective, double-blind, random-assignment study of the efficacy of carbamazepine in the treatment of RCBD.

    Google Scholar 

  27. OkumaT: Effects of carbamazepine and lithium on affective disorders. Neuropsychobiology 1993, 27:138–145.

    Article  PubMed  CAS  Google Scholar 

  28. JoyceP: Carbamazepine in rapid cycling bipolar disorder. Int Clin Psychopharmacol 1988, 3:123–129.

    PubMed  CAS  Google Scholar 

  29. Calabrese J, Rapport D, Shelton M, Kimmel S: Clinical studies on the use of lamotrigine in bipolar disorder. Neuropsychobiology 1998, 38:185–191.

    Article  PubMed  CAS  Google Scholar 

  30. Bowden CL, Calabrese JR, McElroy SL, et al.: The efficacy of lamotrigine in rapid cycling and non-rapid cycling bipolar disorder. Biol Psychiatry 1999, 45:953–958.

    Article  PubMed  CAS  Google Scholar 

  31. Physician’s Desk Reference, edn 54. Montvale, NJ: Medical Economics Data Production Company; 2000.

  32. Calabrese JR, Bowden C, Sachs G, et al., for the Lamictal 602 Study Group: A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. J Clin Psychiatry 1999, 60:79–88. This is the first randomized, double-blind, parallel-group, placebocontrolled evaluation of lamotrigine efficacy in the treatment of bipolar-I depression; results suggest marked antidepressant efficacy is seen, and that lamotrigine may have special utility in the treatment of RCBD.

    Article  PubMed  CAS  Google Scholar 

  33. Gordon A, Price L: Mood stabilization and weight loss with topiramate. Am J Psychiatry 1999, 156:968A-969.

    Google Scholar 

  34. MarcotteD: Use of topiramate, a new anti-epileptic, as a mood stabilizer. J Affect Disorder 1998, 50:245–251.

    Article  CAS  Google Scholar 

  35. Sachs G, Gaughan S, Koslow C, et al.:Topiramate in the treatment of refractory bipolar mood disorder [abstract], oral presentation W8-2. Third International Congress of Neuropsychiatry. Kyoto, Japan: April 9–13 2000.

  36. Chengappa K, Rathore D, Levine J, et al.: Topiramate as add-on treatment for patients with bipolar mania. Bipolar Disord 1999, 1:42–53.

    Article  PubMed  CAS  Google Scholar 

  37. McElroy S, Soutillo C, Keck P: A pilot trial of adjunctive gabapentin therapy in the treatment of bipolar disorder. Ann Clin Psychiatry 1997, 9:99–103.

    Article  PubMed  CAS  Google Scholar 

  38. Pande et al.: Biol Psychiatry 2000, in press.

  39. Calabrese J, Meltzer H, Markovitz P: Clozapine prophylaxis in rapid-cycling bipolar disorder [letter]. J Clin Psychopharmacology 1991, 11:396–397.

    Article  CAS  Google Scholar 

  40. Kimmel S, Calabrese J, Woyshville M, Meltzer H: Clozapine in treatment-refractory mood disorders. J Clin Psychiatry 1994, 55(Suppl B):91–93.

    PubMed  Google Scholar 

  41. Calabrese J, Kimmel S, Woyshville M, et al.: Clozapine for treatment-refractory mania. Am J Psychiatry 1996, 153:759–764.

    PubMed  CAS  Google Scholar 

  42. Suppes T, Phillips K, Judd R: Clozapine treatment of nonpsychotic rapid cycling bipolar disorder: a report of three cases. Biol Psychiatry 1994, 36:338–340.

    Article  PubMed  CAS  Google Scholar 

  43. Suppes T, Webb A, Paul B, et al.: Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. Am J Psychiatry 1999, 156:1164–1169. This is the first controlled trial of clozapine add-on therapy in treatment-refractory bipolar patients with and without RCBD.

    PubMed  CAS  Google Scholar 

  44. Berman E, Wolpert E: Intractable manic depressive psychosis with rapid cycling in an 18 year old woman successfully treated with electroconvulsive therapy. J Nerv Ment Dis 1987, 175:236–239.

    Article  PubMed  CAS  Google Scholar 

  45. Vanelle J-M, Loo H, Galinowski A, et al.: Maintenance ECT in intractable manic depressive disorders. Convuls Ther 1994, 10:195–205.

    PubMed  CAS  Google Scholar 

  46. Frye M, Ketter T, Leverich G, et al.: The increasing use of polypharmacy for refractory mood disorders: 22 years of study. J Clin Psychiatry 2000, 61:9–14. Documentation and discussion of the phenomenon and its implications.

    Article  PubMed  CAS  Google Scholar 

  47. CochranS: Preventing medical noncompliance in outpatient treatment of bipolar affective disorders. J Consult Clin Psychology 1984, 52:873–878.

    Article  CAS  Google Scholar 

  48. Stoll A, Severus W, Freeman M, et al.: Omega-3 fatty acids in bipolar disorder: a preliminary double-blind, placebocontrolled trial. Arch Gen Psychiatry 1999, 56:407–412.

    Article  PubMed  CAS  Google Scholar 

  49. Stoll A, Sachs G, Cohen B, et al.: Choline in the treatment of rapid-cycling bipolar disorder: clinical and neurochemical findings in lithium-treated patients. Biol Psychiatry 1996, 40:382–388.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mood Disorders Program, Department of Psychiatry, Case Western Reserve University School of Medicine, 11400 Euclid Avenue, Suite 200, 44106, Cleveland, Ohio, USA

    Melvin D. Shelton MD, PhD & Joseph R. Calabrese MD

Authors
  1. Melvin D. Shelton MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph R. Calabrese MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shelton, M.D., Calabrese, J.R. Current concepts in rapid cycling bipolar disorder. Curr Psychiatry Rep 2, 310–315 (2000). https://doi.org/10.1007/s11920-000-0073-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-000-0073-8

Keywords

Search

Navigation