You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.


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


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.