Atypical Antipsychotics Preferred in Rapid Cycling Bipolar Disorder

Rapid cycling bipolar disorder (rBPD) occurs in up to 20% of bipolar patients, but it is difficult to treat.

Patients diagnosed with the rapid cycling variant of BPD experience 4 or more distinct episodes of mania annually. Episodes of depression can be more profound and more difficult to resolve.

Fortunately for clinicians, a study published ahead of print in Bipolar Disorder has identified clinical factors associated with the development of rBPD, as well as medications’ role in treating it.

Using a prospective, naturalistic cohort design, researchers examined a sample of 289 patients diagnosed with BPD who had been followed and treated for up to 14 years. This sample contained a higher-than-usual number of patients considered difficult-to-treat.

The investigators identified 48 patients (17%) who experienced rapid cycling and compared them to the 241 patients who did not. All patients had similar autonomies and socioeconomic and work status.

The researchers determined that atypical depressive symptoms and age at BPD onset (i.e. longer duration of being ill) were significantly associated with the development of a rapid cycling course. Long, severe BPD as measured by number of hospitalizations, greater unemployment, and the need for electroconvulsive therapy were also associated with a greater likelihood of rBPD.

The authors noted that earlier diagnosis and treatment would probably have prevented transition to rBPD in some patients.

Generally, patients with rBPD had received a greater number of antidepressants than others. The psychiatry community entertains considerable debate about the use of antidepressants in patients with any kind of BPD, as their use often triggers mania.

Adding to those discussions, the authors stressed that antidepressants should be avoided in patients with rBPD, and they advised using mood stabilizers or atypical antipsychotics preferentially.