Medication for rapid cycling

What is rapid cycling in bipolar disorder?

Rapid cycling refers to the presence of four or more discrete mood episodes (mania, hypomania, depression, or mixed) during a one-year period. Studies have suggested that rapid mood cycling is more frequent in women than in men, and has been associated with hypothyroidism and bipolar II disorder (hypomania rather than mania). It is also associated with longer illness duration, greater illness severity, and worse global functioning.

What is the evidence for pharmaceutical treatments for rapid cycling?

Moderate to low quality evidence suggests the antipsychotics olanzapine, quetiapine, and aripiprazole, and the anticonvulsants divalproex and valproate may be effective for acute clinical response. The anticonvulsant lamotrigine may be more effective than placebo for maintaining stability over time. Antidepressant bupropion may result in a lower risk of switching from depression to mania than antidepressant venlafaxine.

Moderate quality evidence suggests fewer relapses with long-acting injectable risperidone than treatment as usual (various medications).

November 2021

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Last updated at: 5:37 pm, 15th February 2022
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