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The treatment of rapid cycling bipolar disorder 

The treatment of rapid cycling bipolar disorder
The treatment of rapid cycling bipolar disorder

Konstantinos N. Fountoulakis

and Dimos Dimellis

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date: 20 January 2022

Rapid cycling may complicate the course of a significant proportion of patients with bipolar disorder (BD). It is defined in DSM-5 by the occurrence of at least four distinct mood episodes in 12 months. Rapid cycling BD has been consistently associated with worse outcomes compared with non-rapid cycling BD. Thus, rapid cycling BD may require specific treatment strategies. Antidepressants, antipsychotics, and mood stabilizers/anticonvulsants have been studied either as monotherapy or in combination treatments. Concerning the treatment of acute mood episodes, the best available data exist for atypical antipsychotics. On the other hand, maintenance or relapse-prevention treatment, and newer-generation antipsychotics and anticonvulsants seem to be efficacious for rapid cycling BD. Lithium may also be efficacious. Treatment with antidepressants should be avoided in this subpopulation of patients. Overall, few randomized controlled trials have been conducted, and many have been underpowered. Therefore, a significant gap remains in evidence-based treatment of rapid cycling BD.

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