20. Rapid Cycling of Bipolar Patients

  1. Hagop S. Akiskal3 and
  2. Mauricio Tohen4
  1. Athanasios Koukopoulos1,
  2. G. Serra2,
  3. F. Zazzara1,
  4. A. E. Koukopoulos2 and
  5. G. Sani2

Published Online: 13 APR 2011

DOI: 10.1002/9780470975114.ch20

Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition

Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition

How to Cite

Koukopoulos, A., Serra, G., Zazzara, F., Koukopoulos, A. E. and Sani, G. (2011) Rapid Cycling of Bipolar Patients, in Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition (eds H. S. Akiskal and M. Tohen), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470975114.ch20

Editor Information

  1. 3

    International Mood Center, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA

  2. 4

    Department of Psychiatry, Division of Mood and Anxiety Disorders, University of Texas Health Science Centre at San Antonio, 7730 Floyd Curl Drive, San Antonio, TX 78229, USA

Author Information

  1. 1

    Centro Lucio Bini Roma, 42, Via Crescenzio, 00193 Rome, Italy

  2. 2

    Azienda Ospedaliera Sant'Andrea, Università La Sapienza Roma, Rome, Italy

Publication History

  1. Published Online: 13 APR 2011
  2. Published Print: 15 APR 2011

ISBN Information

Print ISBN: 9780470747216

Online ISBN: 9780470975114



  • Rapid Cycling of Bipolar Patients;
  • Epidemiological Data;
  • Rapid cyclers (RCs);
  • Spontaneous and Induced Rapid Cycling;
  • Clinical Picture of Rapid Cycling


Rapid cyclers (RCs) defined as those patients who have at least four affective episodes in a year were rare in the past, as the prepharmacological psychiatric literature shows, and have become increasingly more frequent since the introduction of antidepressant treatments. Ultra-rapid and ultradian rapid cycling is also seen frequently today. The RC course is more frequent in women than in men and bipolar II is more frequent than bipolar I type. The data about the persistence of the RC course are contrasting in the literature. Among our patients, however, the RC course has lasted for many years in more than 50% of them. An important clinical feature of RC, one that made possible their identification by Dunner and Fieve in 1974, is their refractoriness to mood-stabilizing treatments. The authors consider the absence or the extreme shortness of free intervals the cause of this refractoriness. The withdrawal of antidepressant drugs and the use of the most efficacious mood stabilizers including antipsychotic drugs are the basis of the pharmacological treatment. A preliminary naturalistic study with Memantine has yielded promising results.