MB has received grant/research support from the Stanley Medical Research Institute, NARSAD, GlaxoSmithKline, Eli Lilly & Co., AstraZeneca, and Wyeth; has served as an advisor for Eli Lilly & Co., GlaxoSmithKline, Novartis, Servier Deutschland, Bristol-Myers Squibb, and Wyeth; and has received speaker honoraria from AstraZeneca, Eli Lilly & Co., Lundbeck, GlaxoSmithKline, Pfizer, Sanofi-Aventis, and Wyeth. SB has received grant support from CIHR, FRSQQ, NARSAD, RSMQ, and the Stanley Foundation; research support and contracts from AstraZeneca, Biovail, Eli Lilly & Co., Janssen-Ortho, Lundbeck, Merck-Frosst, Novartis, Pfizer, and Servier; has served as an advisor for AstraZeneca, Eli Lilly & Co., GlaxoSmithKline, Janssen-Ortho, and Oryx; and serves on the speakers bureau for AstraZeneca, Biovail, Eli Lilly & Co., GlaxoSmithKline, Janssen-Ortho, Lundbeck, Organon, Oryx, and Wyeth-Ayerst. DLD has received grant support from Eli Lilly & Co., Pfizer, GlaxoSmithKline, Wyeth, Cyberonics, Merck, and Janssen; has served as a consultant to Eli Lilly & Co., Pfizer, GlaxoSmithKline, Wyeth, Bristol-Myers Squibb, Cypress, Corcept, Janssen, Novartis, Shire, Somerset, Otsuka, and Roch Diagnostics; and serves on the speakers bureau for Eli Lilly & Co., Pfizer, GlaxoSmithKline, Wyeth, Bristol-Myers Squibb, Organon, and Forest. RK has received grant support from the Stanley Medical Research Institute and has served on advisory boards and has received speaker honoraria from Eli Lilly & Co., Janssen-Cilag, and AstraZeneca. BL has no reported conflict of interest.
Rapid cycling bipolar disorder – diagnostic concepts
Article first published online: 10 JAN 2008
Volume 10, Issue 1p2, pages 153–162, February 2008
How to Cite
Bauer, M., Beaulieu, S., Dunner, D. L., Lafer, B. and Kupka, R. (2008), Rapid cycling bipolar disorder – diagnostic concepts. Bipolar Disorders, 10: 153–162. doi: 10.1111/j.1399-5618.2007.00560.x
- Issue published online: 10 JAN 2008
- Article first published online: 10 JAN 2008
- Received 22 September 2006, revised and accepted for publication 7 May 2007
- bipolar disorder;
- mood shifts;
- rapid cycling
Objectives: This paper reviews the literature to examine the DSM-IV diagnostic criteria for rapid cycling in bipolar disorder.
Methods: Studies on the clinical characteristics of rapid cycling bipolar disorder were reviewed. To identify relevant papers, literature searches using PubMed and MEDLINE were undertaken.
Results: First observed in the prepharmacologic era, rapid cycling subsequently has been associated with a relatively poor response to pharmacologic treatment. Rapid cycling can be conceptualized as either a high frequency of episodes of any polarity or as a temporal sequence of episodes of opposite polarity. The DSM-IV defines rapid cycling as a course specifier, signifying at least four episodes of major depression, mania, mixed mania, or hypomania in the past year, occurring in any combination or order. It is estimated that rapid cycling is present in about 12–24% of patients at specialized mood disorder clinics. However, apart from episode frequency, studies over the past 30 years have been unable to determine clinical characteristics that define patients with rapid cycling as a specific subgroup. Furthermore, rapid cycling is a transient phenomenon in many patients.
Conclusions: While a dimensional approach to episode frequency as a continuum between the extremes of no cycling and continuous cycling may be more appropriate and provide a framework to include ultra-rapid and ultradian cycling, the evidence does not exist today to refine the DSM-IV definition in a less arbitrary manner. Continued use of the DSM-IV definition also enables comparisons between past and future studies, and it should be included in the next release of the ICD. Further scientific investigation into rapid cycling is needed. In addition to improving the diagnostic criteria, insight into neurophysiologic mechanisms of mood switching and episode frequency may have important implications for clinical care.