Duration and stability of the rapid-cycling course: a long-term personal follow-up of 109 patients

Sani, Gabriele; Koukopoulos, Alexia E.; Minnai, Gian Paolo; Girardi, Paolo; Pani, Luca; Albert, Matthew J.; Reginaldi, Daniela

doi:10.1016/s0165-0327(02)00321-x

Cited by 81 publications

(58 citation statements)

References 29 publications

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“…[37][38][39] Our study corroborates the notion that hypothyroidism and hyperthyroidism are not associated with RC. Confirming the findings of numerous previous studies, 6,7,13,17,20,38 we observed a higher rate of antidepressant use in the RC group. Some authors have found that the likelihood of cycling increases linearly with antidepressant use, with patients taking antidepressants being over three times more likely to have RC than patients who do not use antidepressants.…”

Section: Discussionsupporting

confidence: 91%

“…Some authors have found that the likelihood of cycling increases linearly with antidepressant use, with patients taking antidepressants being over three times more likely to have RC than patients who do not use antidepressants. 26 However, a causative association can be inferred only from prospective studies and, while some support this negative effect of antidepressants, 7,20,40 others did not find the same result. 4,5,41 Some researchers have argued that a non-causal relationship might explain this association, which they attribute to the predominant depressive polarity usually found in RC.…”

Section: Discussionmentioning

confidence: 99%

“…7,11,12 More specifically, many factors have been described to be associated with RC, such as female gender, 5,13 earlier age at onset, 6,12 increased risk for suicide, 13,14 predominance of depression, 15,16 hypothyroidism, 6,17 bipolar type II disorder, 8,18,19 and higher rates of antidepressants use. 7,20 However, some of these associations are still controversial, and many studies have been criticized regarding aspects such as lack of a uniform definition of RC and use of heterogeneous samples. Thus, more studies are needed to clarify which factors are associated with the presence of RC in BD.…”

Section: Introductionmentioning

confidence: 99%

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Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Gigante

Barenboim

Dias

et al. 2016

Rev. Bras. Psiquiatr.

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Objective: Rapid cycling (RC) is a feature of bipolar disorder (BD) that has been associated with worse outcome and more severe disability. Our goal was to investigate the association of demographic and clinical factors with RC. Methods: We compared RC and non-rapid cycling (NRC) BD patients from the Brazilian Research Network in Bipolar Disorder (BRN-BD) regarding age at onset of BD; total number of episodes; previous number of manic, depressive, mixed, and hypomanic episodes; polarity of the first episode; gender; number of suicide attempts; number of lifetime hospitalizations and lifetime history of at least one hospitalization; family history of mood disorder; clinical comorbidities such as hypothyroidism, hyperthyroidism, seizures; and current use of medications such as lithium, anticonvulsants, antipsychotics, and antidepressants. Results: We studied 577 patients and found that 100 (17.3%) met the criteria for RC in the year before the investigation. RC patients had earlier age at onset, longer duration of disease, more lifetime depressive and manic episodes, higher number of suicide attempts, and higher rate antidepressant use. Conclusion: The presence of RC in the previous year was associated with specific clinical characteristics closely related to worse outcome in the course of BD.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Gigante

Barenboim

Dias

et al. 2016

Rev. Bras. Psiquiatr.

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“…Among rapid cyclers, Koukopoulos et al (2003) note that "it is the mania/hypomania-and even the mildest hypomania-that constitutes the most refractory phase of the cycle in...cases that persist cycling rapidly." However, despite the likely prevalence of persistent manic features among rapid cyclers, its clinical significance may often become overshadowed by concomitant depression.…”

mentioning

confidence: 99%

Depression With Versus Without Manic Features in Rapid-Cycling Bipolar Disorder

Goldberg¹,

Wankmuller²,

Sutherland³

2004

Journal of Nervous &Amp; Mental Disease

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Depression has been identified as a hallmark feature of rapid-cycling bipolar disorder, although less attention has been paid to the presence of manic features accompanying depression in rapid cyclers. To provide greater information about the extent to which depression arises with or without salient manic features in rapid cycling, we conducted a preliminary study of rapid cycling in outpatients seeking treatment at an academic specialty center for bipolar disorder. Forty DSM-IV affectively symptomatic bipolar outpatients with past year DSM-IV rapid cycling underwent systematic evaluation of symptoms and illness characteristics. Manic and depressive symptoms, treatments, and clinical features were rated by standardized scales. Major depression was present in most rapid cyclers (85%), but salient manic features were also evident in half of all depressed rapid cyclers. A lifetime history of suicide attempts was significantly more common in rapid cyclers who presented with major depression plus salient manic features than in those who presented with pure depression or pure mania (p = .033). Antidepressants were being prescribed for approximately one third of depressed rapid cycling patients regardless of the presence of concomitant manic features, whereas mood stabilizers tended to be used less often when manic features accompanied depression. Depression in conjunction with manic symptoms, rather than pure depression alone, may be more common among rapid-cycling bipolar patients who seek treatment. Lifetime suicide risk may be greater among rapid cycling patients whose depression occurs in tandem with manic symptoms. Prescribing habits in the community that favor antidepressants over mood stabilizers may promote further mood destabilization in this population. Further studies with larger sample sizes are needed to affirm these provisional findings.

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“…In panic disorder, both SSRIs and TCAs have demonstrated significant improvements in controlled trials (Otto et al, 2001). However, in patients with bipolar disorder, antidepressant drugs can cause manic or hypomanic switches (Calabrese et al, 1999;Perugi et al, 1999;Perugi et al, 2002b;Koukopoulos et al, 2003). Adequate mood stabilization should be achieved before antidepressants are used to treat residual anxiety symptoms in order to minimize the risk of antidepressant-induced mania or cycling .…”

Section: Efficacy Of New Bipolar Treatments In Treating Comorbid Disomentioning

confidence: 99%

Comorbidity in bipolar disorder: a framework for rational treatment selection

McIntyre

Konarski

Yatham

2004

Human Psychopharmacology

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Bipolar disorders are heterogeneous disorders often requiring multimodality treatment. The expanding pharmacopeia for bipolar disorders invites the need for a treatment framework that both recognizes and anticipates the multidimensionality and comorbidity of the illness. No available neurotherapeutic agent is singularly efficacious for the complete mélange of bipolar symptomatology. An apparent paradox has emerged in the management of bipolar disorder; whilst results from rigorous controlled monotherapy trials suggest that a disparate assortment of neurotherapeutic agents are efficacious in distinct phases of bipolar disorder, the majority of tertiary-treated bipolar patients receive polypharmacotherapeutic regimens. The evidentiary base for polypharmacotherapy is sparse and has recently become an area of active research focus. In the interim, clinicians are encouraged to invoke an organizational schema for the treatment of bipolar disorder that considers the spectrum of effectiveness of putative and established mood stabilizers. This schema should be further informed by the treatment data for comorbid and accessory conditions. The authors propose a schema to provide the impetus for further work in the area.

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Duration and stability of the rapid-cycling course: a long-term personal follow-up of 109 patients

Cited by 81 publications

References 29 publications

Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Depression With Versus Without Manic Features in Rapid-Cycling Bipolar Disorder

Comorbidity in bipolar disorder: a framework for rational treatment selection

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