Algorithm for the treatment of rapid cycling

Rapid cycling is a clinical subtype of bipolar mood disorder that has four or more episodes during the previous 12 months and has poor response to lithium (Li) prophylaxis treatment. Therefore it is said the refractory mood disorder and algorithm for treatment of rapid cycling is to be expected. The first choice of drug for rapid cycling is Li, the second choice is carbamazepine (CBZ) or valproic acid (VPA), in addition to Li, the third choice is clonazepam (CNZP) in addition to Li, and CBZ or VPA, the fourth choice is levothyroxine or bromocriptine in addition to them, and the fifth choice is electroconvulsive therapy.