Bipolar disorder rapid-cycling

Nimodipine may be more effective than verapamil for rapid-cycling bipolar disorder because of its anticonvulsant properties, high lipid solubility, and good penetration into the brain. 

Fatemi, S.H., Rapport, D.J., Calabrese, J.R., and Thuras, P. (1997) Lamotrigine in rapid-cycling bipolar disorder. Clin Psychiatry 58 522-527. 

Sovner, R. (1991) Divalproex-responsive rapid cycling bipolar disorder in a patient with Down s syndrome implications for the Down s syndrome-mania hypothesis. J Ment Defic Res 35 171-173. 

Lambert 1984 McElroy et al. 1988b] suggested that valproate may be a much better antimanic than antidepressant agent. In a study of 78 consecutively recruited patients with rapid-cycling bipolar disorder treated with open-label valproate alone or in combination with other psychotropic agents, Calabrese and colleagues [Calabrese and Delucchi 1990 Calabrese et al. 1992] reported a 54% valproate response in acute mania, an 87% response in acute mixed states, and a 19% response in acute depression. However, they did observe a prophylactic antidepressant effect in patients subsequently. Additional controlled studies are needed to clarify valproate s antidepressant efficacy. 

Several studies suggest that valproate is effective in patients with a history of lithium treatment failure. In the study by Pope et al. [1991), 71% of patients receiving valproate exhibited an antimanic response, even though all of the patients had a history of lithium treatment failure or intolerance. Sixty-four percent of the patients with rapid-cycling bipolar disorder studied by Galabrese and Delucchi [1990) had a history of lithium failure, and the majority of these subsequently responded to valproate. Similarly, the six patients with rapid-cycling bipolar disorder described by McElroy et al. 

It is worthwhile noting that the combined treatment of T4 and lithium for patients with rapid-cycling bipolar disorder is reported to be more effective than lithium alone [Whybrow 1994], whereas T4 by itself is not effective and in high dosages may even cause hypomania or manic states. 

Goodnick PJ Nimodipine treatment of rapid cycling bipolar disorder (letter). J Clin Psychiatry 56 330, 1995... 

McElroy SL, Keck PE Jr, Pope EIG Jr, et al Valproate in primary psychiatric disorders literature review and clinical experience in a private psychiatric hospital, in Use of Anticonvulsants in Psychiatry Recent Advances. Edited by McElroy SL, Pope HG Jr. Clifton, NJ, Oxford Health Care, 1988b McElroy SL, Keck PE Jr, Pope HG Jr, et al Valproate in the treatment of rapid-cycling bipolar disorder. J Clin Psychopharmacol 8 275-279, 1988c McElroy SL, Sessain EC, Pope HG Jr, et al Clozapine in the treatment of psychotic mood disorders, schizoaffective disorder and schizophrenia. J Clin Psychiatry 52 411-414, 1991a... 

Whitworth P, Kendall DA Effects of lithium on inositol phospholipid hydrolysis and inhibition of dopamine D, receptor-mediated cyclic AMP formation by carbachol in rat brain slices. J Neurochem 53 536-541, 1989 Whybrow PC The therapeutic use of triiodothyronine and high dose thyroxine in psychiatric disorder. Acta Med Austriaca 21 44-47, 1994 Whybrow PC Update on thyroid axis approaches to treatment of rapid cycling bipolar disorder. Paper presented at the annual meeting of the New Clinical Drug Evaluations Unit (NCDEU), Boca Raton, EL, May 30, 1996... 

Lithium has been proven effective for acute and prophylactic treatment of both manic and depressive episodes in patients with bipolar illness (American Psychiatric Association 2002). However, patients with rapid-cycling bipolar disorder (i.e., patients who experience four or more mood disorder episodes per year) have been reported to respond less well to lithium treatment (Dunner and Fieve 1974 Prien et al. 1984 Wehr et al. 1988). Lithium is also effective in preventing future depressive episodes in patients with recurrent unipolar depressive disorder (American Psychiatric Association 2002) and as an adjunct to antidepressant therapy in depressed patients whose illness is partially refractory to treatment with antidepressants alone (discussed in Chapter 2). Furthermore, hthium may be useful in maintaining remission of depressive disorders after electroconvulsive therapy (Coppen et al. 1981 Sackeim et al. 2001). Lithium also has been used effectively in some cases of aggression and behavioral dyscontrol. 

Calabrese JR, Suppes T, Bowden CL, et al A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Lamictal 614 Study Group. J Clin Psychiatry 61 841—850,... 

SuppesT, Phillips KA, Judd CR. Clozapine treatment of nonpsychotic rapid cycling bipolar disorder a report of three cases. Biol Psychiatry 1994 36 338-340. 

Afflelou S, Auriacombe M, Cazenave M, et al. Administration of high dose levothyroxine in treatment of rapid cycling bipolar disorders. Review of the literature and initial therapeutic apropos of 6 cases. Encephale 1997 23 207-217. 

Earl NL, Greene P, Ascher J, et al. Mood stabilization with lamotrigine in rapid-cycling bipolar disorder. Presented at the American Psychiatric Association Annual Meeting, Chicago, May 13-18, 2000. 

Leibenluft E, Feldman-Naim S, Turner EH, Wehr TA, Rosenthal NE. Effects of exogenous melatonin administration and withdrawal in five patients with rapid-cycling bipolar disorder. J Clin Psychiatry 1997 58(9) 383-8. 

Leibenluft E, Albert PS, Rosenthal NE, WehrTA (1996) Relationship between sleep and mood in patients with rapid-cycling bipolar disorder. Psychiatry Res 63 161-168... 

Muller DJ, de Luca V, Sicard T, King N, Strauss J, Kennedy JL. Brain-derived neurotrophic factor (BDNF) gene and rapid-cycling bipolar disorder family-based association study. Br J Psychiatry 2006 189 317-23. 

Calabrese JR, Shelton MD, rapport DJ, Youngstrom EA, Jackson K, Bilali S, Ganocy SJ, Findling RL. A 20-month, double-bhnd, maintenance trial of lithium versus divalproex in rapid cycling bipolar disorder. Am J Psychiatry 2005 162 2152-61. 

Chen CK, Shiah IS, Yeh CB, Mao WC, Chang CC. Combination treatment of clozapine and topiramate in resistant rapid-cycling bipolar disorder. Clin Neuropharmacol 2005 28 136-8. 

Two patients, one with treatment-resistant rapid cycling bipolar disorder (36) and the other with severe mood changes during corticosteroid therapy (37), improved with olanzapine. 

Patients with bipolar disorders may benefit from risperidone. This has been observed in an open trial of ten patients with rapid cycling bipolar disorder who were refractory to lithium carbonate, carbamazepine, and valproate eight improved after 6 months of treatment. One patient dropped out through non-adherence to therapy and one because of adverse effects (agitation, anxiety, insomnia, and headache) (5). There was a similar beneficial effect in eight adults with moderate to profound mental retardation (6). Risperidone was associated with a significant reduction in aggression and self-injurious behavior, whereas adverse effects were primarily those of sedation and restlessness. 

Vieta E, Gasto C, Colom F, Martinez A, Otero A, Vallejo J. Treatment of refractory rapid cycling bipolar disorder with risperidone. J Clin Psychopharmacol 1998 18(2) 172 1. 

Valproate is a first-line treatment option that may be best for patients with mixed states of bipolar disorder or for patients with rapid-cycling bipolar disorder... 

Carbamazepine is licenced as an alternative to lithium for prophylaxis of bipolar affective disorder, although clinical trial evidence is actually stronger to support its use in the treatment of acute mania. Carbamazepine appears to be more effective than lithium for rapidly cycling bipolar disorders, i.e. with recurrent swift transitions from mania to depression. It is also effective in combination with lithium. Its mode of action is thought to involve agonism of inhibitory GABA transmission at the GABA-benzodiazepine receptor complex (see also Epilepsy, p. 417). 

Lamotrigine has been nsed as maintenance monotherapy for rapid-cycling bipolar disorder in 324 patients (open label) and 182 patients (donble-bUnd) with rapidcycling bipolar disorder (5). In aU, 265 patients reported adverse events during the open phase. The most common adverse events (over 10%) were headache, infection, influenza, nausea, abnormal dreams, dizziness, and rash. During the donble-bUnd phase 122 patients reported adverse events, eqnaUy with lamotrigine and placebo. 

Rapid cycling bipolar disorder warrants special attention, due to the diagnostic and treatment challenges it presents. Rapid cycling is defined as at least four episodes of either mania, hypomania, or major depression in the previous twelve months. The characteristics of rapid cycling are these ... 

Herridge PL, Pope HG. Treatment of bulimia and rapid cycling bipolar disorder with sodium valproate A case report. J din Psychopharmacol 1985 5 229-230. 

Barrios C, Chaudhry TA, Goodnick PJ. Rapid cycling bipolar disorder. Expert Opin Pharmacother 2001 2 1963-1973. 

I It is used as an adjunct to lithium in the prophylaxis of bipolar affective disorder and has been considered to have particular value in rapid-cycling bipolar disorder. 

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