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The long-term course of rapid-cycling bipolar disorder
Journal article   Peer reviewed

The long-term course of rapid-cycling bipolar disorder

William Coryell, David Solomon, Carolyn Turvey, Martin Keller, Andrew C Leon, Jean Endicott, Pamela Schettler, Lewis Judd and Timothy Mueller
Archives of general psychiatry, Vol.60(9), pp.914-920
09/2003
DOI: 10.1001/archpsyc.60.9.914
PMID: 12963673

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Abstract

Rapid cycling among patients with bipolar affective disorders is important because of its implications for long-term prognosis and for the use of antidepressants. To our knowledge, no prospective study has, as yet, described the course of this phenomenon beyond 5 years. From 345 patients with bipolar I or bipolar II disorder followed up for a mean (SD) of 13.7 (6.1) years as part of the National Institute of Mental Health Collaborative Depression Study, 89 (25.8%) were identified who, during 1 or more years of follow-up, manifested a pattern that met DSM-IV criteria for rapid cycling. These patients were compared with the remaining bipolar patients by demographics, overall affective morbidity, morbidity during specific treatment conditions, and the likelihood of suicidal behavior. Analyses assessed whether the use of tricyclic antidepressants for depressive symptoms was associated with the persistence of rapid cycling or with tendencies to switch from depressive to manic or hypomanic phases. The 89 patients who showed a rapid cycling pattern were significantly more likely to have had an illness onset before 17 years of age and were more likely to make serious suicide attempts. In 4 of 5 cases, rapid cycling ended within 2 years of its onset. Resolutions were not associated with decreases in tricyclic antidepressant use. Throughout follow-up, patients prone to rapid cycling experienced more depressive morbidity than other bipolar patients, particularly when lithium carbonate was being used without tricyclic antidepressants. The use of these antidepressants was not more likely in the weeks preceding shifts from depression to mania or hypomania. These results indicate that bipolar patients who develop a rapid cycling pattern suffer substantial depressive morbidity and are at high risk for serious suicide attempts. These findings do not implicate tricyclic antidepressants or, by inference, serotonin reuptake inhibitors in the promotion of affective instability.
 Prospective Studies Follow-Up Studies Humans Suicide, Attempted - statistics & numerical data Anticonvulsants - therapeutic use Male Treatment Outcome Bipolar Disorder - diagnosis Bipolar Disorder - drug therapy Bipolar Disorder - psychology Suicide, Attempted - psychology Lithium - therapeutic use Antidepressive Agents, Tricyclic - therapeutic use Age of Onset Survival Analysis Adult Female Drug Therapy, Combination Longitudinal Studies

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