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Treating Rapid Cycling in Bipolar Disorder

The following treatment guidelines are meant as a reference tool, but are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

Rapid Cycling refers not to a particular Bipolar mood episode, but to when a person experiences four or more discrete episodes (Hypomania, Mania, Depressive or Mixed) within a year. Although the treatments for Bipolar Disorder are chosen based mainly on the kind of mood episode that a person is experiencing at any given time, there are certain additional treatment recommendations for when any given mood episode is occuring within the context of Rapid Cycling.

The first step is to remove any factors that may be contributing to the Rapid Cycling pattern:

  • Antidepressants are thought to worsen or even lead to Rapid Cycling [ref], and so they must be discontinued in these cases.
  • Alcohol and illicit drugs should also be stopped, as they can also contribute to Rapid Cycling.
  • Hypothyroidism (a medical condition where insufficient Thyroid Hormone is being produced by the body) can lead to Rapid Cycling and should be corrected.

When choosing medications, there are a few that have been shown to have some benefit in stopping Rapid Cycling. If possible, these should be given priority when treating any Bipolar mood episode that is occuring in the context of Rapid Cycling:

 

Unless otherwise indicated, the above treatments strategies are based on the CANMAT Guidelines for the Management of Patients with Bipolar Disorder [ref, ref].

 

Bipolar II Depression

Comorbid Anxiety Disorders