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Tips for Managing Rapid Cycling

The limited evidence from systematic studies of rapid-cycling bipolar disorder leaves much to the clinician's judgment. However, general guidelines include the following:

First, rule out medical etiologies, including endocrinopathies (eg, hypothyroidism), neurologic disorders with psychiatric manifestations (eg, multiple sclerosis and pseudobulbar palsy), and psychoactive substances of abuse (eg, cocaine and steroids).
Consider lithium, valproate, and/or lamotrigine as a first-line treatment. Lithium or valproate may be better choices for acutely manic patients, and lamotrigine may be more appropriate for the acutely depressed. Atypical antipsychotics, notably olanzapine or quetiapine, also have demonstrated evidence-based efficacy in rapid cycling.
Antidepressant monotherapies should seldom, if ever, be used in rapid cycling, and the discontinuation of antidepressants alone may help to ameliorate rapid cycling. If antidepressants are used, patients should be monitored carefully for signs of affective switching.
Consider electroconvulsive therapy in treatment-refractory or severely ill patients.
Educate all patients about their illness and the importance of lifestyle manipulations to avoid relapse. These include maintaining a regular sleep/wake cycle, managing stress, adhering to medication regimens, and avoiding alcohol and recreational drug use.

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Conclusion

References

Rapid-Cycling Bipolar Disorder: Emerging Treatments and Enduring Controversies: Tips for Managing Rapid Cycling

Tips for Managing Rapid Cycling

Table of Contents

References

Faculty and Disclosures

Rapid-Cycling Bipolar Disorder: Emerging Treatments and Enduring Controversies: Tips for Managing Rapid Cycling

Tips for Managing Rapid Cycling

Table of Contents