The course of 434 bipolar patients (256 women, 178 men) was studied longitudinally. The prevailing patterns of the manic-depressive cycles at the end of the observation time were: mania followed by depression (usually mild), 28%; depression followed by mania (usually hypomania), 25%; and continuous circular course, with long cycles, 19%, or with short (rapid) cycles, 20%. The cycles followed an irregular pattern in 8% of the patients.As to the intensity of the episodes, 52% of the patients had severe depressions and hypomanias; 26% had severe manias and mild depressions; and 22% had severe depressions and severe manias. No significant sex differences was found regarding the patterns of the cycles or the intensity of the episodes, except among the rapid cyclers, where women (61) outnumbered men (26).With time the course tended to change from monopolar to bipolar, and the frequency of recurrence increased. Concurrent treatments, expecially antidepressants, contributed to these changes, while fern ale sex, middle age and menopause, along with antidepressant drugs, contributed to the establishment of rapid cyclicity. The depression-hypomania course was the one which was most prone to rapid cyclicity.Response to lithium prophylaxis was good in the maniadepression-free interval course, in the continuous circular course with long cycles, and in the irregular course. It was less good in the depression-mania-free interval course, where it increased the frequency of recurrences, although these were shorter and milder. Response was very poor in the rapid cycling course. But rapid cyclers and patients with the depressionmania-free interval course responded weil to lithium when antidepressant drugs were not administered during the depressions.Verlauf des manisch-depressiven Zyklus und die durch Behandlung verursachten Veränderungen Der Verlauf der manisch-depressiven Zyklen bei 434 Patienten (256 Frauen, 178 Männer) wurde longitudinal untersucht. Die am Ende der Beobachtungszeit überwiegenden Verlaufsarten der manisch-depressiven Zyklen waren: Manie mit nachfolgender Depression (meist mild), 28%; Depression mit nachfolgender Manie (meist Hypomanie), 25%; kontinuierlich zyklischer Verlauf mit langen Zyklen, 19%; oder mit kurzen (schnellen) Zyklen, 20%. 8% der Patienten hatten Zyklen mit unregelmäßiger Verlaufsart. Hinsichtlich der Intensität der Episoden wurden folgende Beobachtungen gemacht: 52% der Patienten hatten schwere Depressionen und Hypomanien: 26% hatten schwere Manien und leichte Depressionen; 22% hatten schwere Depressionen und schwere Manien. Bei den Verlaufsarten der Zyklen oder der Intensität der Episoden gab es keine signifikanten geschlechtsspezifischen Unterschiede, mit Ausnahme der Patienten mit schnellen Zyklen, bei denen die Frauen (61) zahlenmäßig stärker vertreten waren als die Männer (26). Mit der Zeit bestand eine Tendenz zur Veränderung von monopolar nach bipolar und zu einer Zunahme der Häufigkeit von Rezidiven. Gleichzeitig vorgenommene Behandlungen, insbesondere mit Antidepressiva, trugen zu solche...

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434 bipolar manic-depressive patients were followed longitudinally. The course of the disease changed in many patients over the years. 67 cases became rapid cyclers (two or more cycles per year); in 40 of these cases (12 men and 28 women) the change of the course took place after intense or protracted use of antidepressant drugs. In their previous course these patients had not received antidepressant drugs. The common feature of the transformation of the previous course to a continuous circular one was the appearance for the first time in the course of the disease of hypomanie episodes after the depressions, or the accentuation of hypomanias that had been of milder intensity in previous recurrences. The patients who developed continuous circularity under antidepressant drug treatment were of highly energetic temperament. The hypothesis is advanced that these patients have latent hypomanias, which become clinically manifest under the action of antidepressants. The intensification of an underlying hypomanie process by the antidepressants would precipitate another depression and establish continuous circularity. The change to a rapid cyclical course was more frequent in middle-aged patients and in women.

41 patients with recurrent endogenous affective disorders were given continuous lithium treatment for periods varying from 3 months to 2‘/2 years; the prophylactic action of lithium was confirmed. It was observed that a depressive episode was generally prevented or attenuated by lithium only when a preceding manic episode had been prevented or attenuated by lithium. The hypothesis of ‘subclinical’ manic phases is considered.