Abstract
IntroductionRapid cycling bipolar disorder (RCBD) is defined as four or more affective episodes (depression, mania or hypomania) within 1 year. RCBD has a high point of prevalence (from 10% to 20% among clinical bipolar samples) and is associated with greater severity, longer illness duration, worse global functioning and higher suicidal risk, but there is no consensus on treatment option. The use of several pharmacological agents has been reported (levothyroxine, antipsychotics, antidepressants and mood stabilizers).ObjectiveThe main objective of this review was to propose a critical review of the literature and to rank the pharmacological agent using a level of evidence (LEO) adapted from the Center for Evidence‐Based Medicine, and to illustrate it with a case report on off‐label intravenous ketamine.MethodWe conducted a review using the MeSH terms and keywords (bipolar [Title/]) AND (rapid [Title/]) AND (cycling [Title/]) AND (treatment [Title/]). Alexis Bourla and Stéphane Mouchabac screened 638 documents identified through literature search in Medline (PubMed) or by bibliographic references and 164 abstracts were then analyzed. Nonpharmacological treatments were excluded.ResultSeventy articles were included in the review and divided into six categories: mood stabilizers, antipsychotics, hormonal treatments, ketamine and other pharmacological treatments.DiscussionOur review highlights the heterogeneity of the pharmacological treatment of RCBD and no clear consensus can emerge.
Highlights
Rapid cycling bipolar disorder (RCBD) is defined as four or more affective episodes within 1 year
We found only one case report supporting the use of ketamine for RCBD (Sampath et al, 2016): a 19-year-old female with suicidal depression resistant to lithium and quetiapine who refused electroconvulsive therapy (ECT) and was treated with ketamine IV, 0.5 mg/kg in 100 ml saline over 40 min
Our review highlights the heterogeneity of the pharmacological treatment of RCBD, and no clear consensus can emerge
Summary
Rapid cycling bipolar disorder (RCBD) is defined as four or more affective episodes (depression, mania or hypomania) within 1 year. RCBD has a high point of prevalence (from 10% to 20% among clinical bipolar samples) and is associated with greater severity, longer illness duration, worse global functioning and higher suicidal risk, but there is no consensus on treatment option. The use of several pharmacological agents has been reported (levothyroxine, antipsychotics, antidepressants and mood stabilizers). There is a clear paradox since RCBD has a high point of prevalence (from 10% to 20% among clinical bipolar samples) and is associated with greater severity, longer illness duration, worse global functioning and higher suicidal risk (Coryell et al, 2003; Kupka et al, 2005; Schneck et al, 2004), but there is no consensus on treatment option. In a previous review, Fountoulakis et al (2016) reported the use of several pharmacological agents: levothyroxine, antipsychotics, antidepressants and mood stabilizers. Several evidence support effectiveness of ketamine in treatment-resistant cases of bipolar depression (Bobo et al, 2016; McIntyre et al, 2021), there are few data on the effectiveness and risk of ketamine for RCBD
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