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The long-term course of rapid-cycling bipolar disorder.

Abstract

BACKGROUND

Rapid cycling among patients with bipolar affective disorders is important because of its implications for long-term prognosis and for the use of antidepressants. To our knowledge, no prospective study has, as yet, described the course of this phenomenon beyond 5 years.

METHODS

From 345 patients with bipolar I or bipolar II disorder followed up for a mean (SD) of 13.7 (6.1) years as part of the National Institute of Mental Health Collaborative Depression Study, 89 (25.8%) were identified who, during 1 or more years of follow-up, manifested a pattern that met DSM-IV criteria for rapid cycling. These patients were compared with the remaining bipolar patients by demographics, overall affective morbidity, morbidity during specific treatment conditions, and the likelihood of suicidal behavior. Analyses assessed whether the use of tricyclic antidepressants for depressive symptoms was associated with the persistence of rapid cycling or with tendencies to switch from depressive to manic or hypomanic phases.

RESULTS

The 89 patients who showed a rapid cycling pattern were significantly more likely to have had an illness onset before 17 years of age and were more likely to make serious suicide attempts. In 4 of 5 cases, rapid cycling ended within 2 years of its onset. Resolutions were not associated with decreases in tricyclic antidepressant use. Throughout follow-up, patients prone to rapid cycling experienced more depressive morbidity than other bipolar patients, particularly when lithium carbonate was being used without tricyclic antidepressants. The use of these antidepressants was not more likely in the weeks preceding shifts from depression to mania or hypomania.

CONCLUSIONS

These results indicate that bipolar patients who develop a rapid cycling pattern suffer substantial depressive morbidity and are at high risk for serious suicide attempts. These findings do not implicate tricyclic antidepressants or, by inference, serotonin reuptake inhibitors in the promotion of affective instability.

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  • Authors+Show Affiliations

    ,

    National Institute of Mental Health Collaborative Program on the Psychobiology of Depression-Clinical Studies, National Institutes of Health, Bethesda, MD, USA. william-coryell@uiowa.edu

    , , , , , , ,

    Source

    Archives of general psychiatry 60:9 2003 Sep pg 914-20

    MeSH

    Adult
    Age of Onset
    Anticonvulsants
    Antidepressive Agents, Tricyclic
    Bipolar Disorder
    Drug Therapy, Combination
    Female
    Follow-Up Studies
    Humans
    Lithium
    Longitudinal Studies
    Male
    Prospective Studies
    Suicide, Attempted
    Survival Analysis
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Multicenter Study
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12963673

    Citation

    Coryell, William, et al. "The Long-term Course of Rapid-cycling Bipolar Disorder." Archives of General Psychiatry, vol. 60, no. 9, 2003, pp. 914-20.
    Coryell W, Solomon D, Turvey C, et al. The long-term course of rapid-cycling bipolar disorder. Arch Gen Psychiatry. 2003;60(9):914-20.
    Coryell, W., Solomon, D., Turvey, C., Keller, M., Leon, A. C., Endicott, J., ... Mueller, T. (2003). The long-term course of rapid-cycling bipolar disorder. Archives of General Psychiatry, 60(9), pp. 914-20.
    Coryell W, et al. The Long-term Course of Rapid-cycling Bipolar Disorder. Arch Gen Psychiatry. 2003;60(9):914-20. PubMed PMID: 12963673.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The long-term course of rapid-cycling bipolar disorder. AU - Coryell,William, AU - Solomon,David, AU - Turvey,Carolyn, AU - Keller,Martin, AU - Leon,Andrew C, AU - Endicott,Jean, AU - Schettler,Pamela, AU - Judd,Lewis, AU - Mueller,Timothy, PY - 2003/9/10/pubmed PY - 2003/10/24/medline PY - 2003/9/10/entrez SP - 914 EP - 20 JF - Archives of general psychiatry JO - Arch. Gen. Psychiatry VL - 60 IS - 9 N2 - BACKGROUND: Rapid cycling among patients with bipolar affective disorders is important because of its implications for long-term prognosis and for the use of antidepressants. To our knowledge, no prospective study has, as yet, described the course of this phenomenon beyond 5 years. METHODS: From 345 patients with bipolar I or bipolar II disorder followed up for a mean (SD) of 13.7 (6.1) years as part of the National Institute of Mental Health Collaborative Depression Study, 89 (25.8%) were identified who, during 1 or more years of follow-up, manifested a pattern that met DSM-IV criteria for rapid cycling. These patients were compared with the remaining bipolar patients by demographics, overall affective morbidity, morbidity during specific treatment conditions, and the likelihood of suicidal behavior. Analyses assessed whether the use of tricyclic antidepressants for depressive symptoms was associated with the persistence of rapid cycling or with tendencies to switch from depressive to manic or hypomanic phases. RESULTS: The 89 patients who showed a rapid cycling pattern were significantly more likely to have had an illness onset before 17 years of age and were more likely to make serious suicide attempts. In 4 of 5 cases, rapid cycling ended within 2 years of its onset. Resolutions were not associated with decreases in tricyclic antidepressant use. Throughout follow-up, patients prone to rapid cycling experienced more depressive morbidity than other bipolar patients, particularly when lithium carbonate was being used without tricyclic antidepressants. The use of these antidepressants was not more likely in the weeks preceding shifts from depression to mania or hypomania. CONCLUSIONS: These results indicate that bipolar patients who develop a rapid cycling pattern suffer substantial depressive morbidity and are at high risk for serious suicide attempts. These findings do not implicate tricyclic antidepressants or, by inference, serotonin reuptake inhibitors in the promotion of affective instability. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/12963673/full_citation L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=12963673.ui DB - PRIME DP - Unbound Medicine ER -