Overview
Rapid cycling bipolar disorder (RCBD) is a severe and disabling phase of bipolar disorder characterized by increased mood episode frequency 12. It presents a significant clinical challenge 1.Diagnosis
Management
Acute Mania/Mixed Episodes: Aripiprazole, olanzapine, and valproate are supported by evidence for treating acute manic or mixed episodes in RCBD 1. Quetiapine and olanzapine also show benefits for mania 2.
Acute Depressive Episodes: Quetiapine is supported by evidence for treating acute depressive episodes in RCBD 1. Olanzapine (with or without fluoxetine), citalopram, and venlafaxine suggest significant depression benefits compared to placebo 2.
Relapse Prevention: Lamotrigine is mentioned as a treatment option 1. Quetiapine and lamotrigine have been assessed in more than 5 studies 2.
Other Treatments: Lithium, other anticonvulsants, second-generation antipsychotics, antidepressants, and thyroid hormone have been assessed 1.Special Populations
Key Recommendations
Evidence supports the use of aripiprazole, olanzapine, and valproate for acute manic or mixed episodes in rapid cycling bipolar disorder 1. (Evidence: Moderate)
Evidence supports the use of quetiapine for acute depressive episodes in rapid cycling bipolar disorder 1. (Evidence: Moderate)
Olanzapine (with or without fluoxetine), citalopram, and venlafaxine suggest significant depression benefits in rapid cycling bipolar disorder 2. (Evidence: Moderate)References
1 Roosen L, Sienaert P. Evidence-based treatment strategies for rapid cycling bipolar disorder, a systematic review. Journal of affective disorders 2022. link
2 Strawbridge R, Kurana S, Kerr-Gaffney J, Jauhar S, Kaufman KR, Yalin N et al.. A systematic review and meta-analysis of treatments for rapid cycling bipolar disorder. Acta psychiatrica Scandinavica 2022. link