Rapid-cycling bipolar disorder - An overview of research and clinical experience

Rapid-cycling bipolar disorder (RCBD) has been recognized as a refractory course pattern of the illness in up to 20% of bipolar, especially type II, patients. Data are generally consistent in indicating that RCBD is more common in women. Familial bipolarity does not distinguish RCBD from other bipolar patients. This article reviews evidence of putative risk factors, such as antecedent cyclothymic temperament, borderline hypothyroidism, and exposure to antidepressant medications; however, de novo rapid-cycling in the absence of such factors also occurs. Clinicians are admonished to refrain from using antidepressants-with the possible exception of bupropion-and to maintain patients on mood stabilizer combinations of which valproate appears to be the most useful ingredient.