What is the best treatment for rapid cycling bipolar disorder? Bipolar disorder.March .2013

18.03.2013

Rapid cycling (four or more discrete mood episodes during a one-year period in the context of bipolar disorder) occurs in 10-20% of bipolar clinical samples.It is more associated with hypothyroidism, bipolar 2,longer duration of illness,greater severity and is more frequent in women.Rapid cycling is an independent predictor for inadequate treatment response. Rapid cycling patients do worse in follow-up than patients without rapid cycling

Fountoulakis KN, Kontis D, Gonda X and Yatham LN report the results of the systematic review that examined the evidence for what works in rapid cycling disorder.They identified 24 studies.

Findings:

1.Lithium and anticonvulsants have comparable efficacies in rapid cyclers. This is in contrast to earlier notions that Lithium do not work in this group. However the response rates for both are low.

2. Usefulness of the combination of anticonvulsants compared with anticonvulsant monotherapy in rapid cyclers are contradictory.

3. Atypical antipsychotics aripiprazole, olanzapine, and quetiapine are effective in acute bipolar episodes of rapid cyclers. Olanzapine is equally effective to anticonvulsants during acute treatment.  Quetiapine seems more effective for the prophylaxis of exacerbation of depressive than manic symptoms.

4.Aripiprazole, olanzapine, and quetiapine appear promising for the maintenance of response in rapid cyclers.

5.There is an association between antidepressant use and the presence of rapid cycling.The existence of a causal relationship cannot yet be established.

6.Rapid cycling patients show a less favorable long-term outcome and initial response may not predict long term outcome.

Comments: Most studies are small and underpowered. Most clinically relevant questions still remain unanswered.

Summary of the article:

systematic review of the evidence on the treatment of rapid cycling bipolar disorder.

Fountoulakis KN, Kontis D, Gonda X, Yatham LN. Bipolar Disord. 2013 Mar;15(2):115-37

summary

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