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Rapid cycling bipolar disorder: biology and pathogenesis
George N Papadimitriou1, Joseph R Calabrese, Dimitris G Dikeos
1Department of Psychiatry, Athens University Medical School, Eginition Hospital, Athens, Greece. gnpapad@med.uoa.gr
The International Journal of Neuropsychopharmacology
|March 2, 2005
Summary
Rapid cycling (RC) is a severe mood disorder pattern affecting 10-30% of bipolar patients, predominantly women. Emerging research suggests potential links to subclinical hypothyroidism and circadian rhythm disruptions.
Area of Science:
- Psychiatry
- Mood Disorders
- Bipolar Disorder
Background:
- Rapid cycling (RC) is defined by at least four affective episodes annually, with switches in polarity or 2-month remissions.
- RC is uncommon in unipolar disorders but affects 10-30% of bipolar patients, primarily women (70-90%).
- Patients often have bipolar II disorder, initiating with depression.
Purpose of the Study:
- To review current understanding of rapid cycling in mood disorders.
- To explore potential contributing factors and triggers for rapid cycling.
Main Methods:
- Literature review of genetic, endocrine, and chronobiological factors.
- Analysis of clinical presentation and treatment-related influences.
Main Results:
- Genetic links remain inconclusive.
- Subclinical hypothyroidism is a potential factor in cycle acceleration.
- Circadian rhythm disruptions may influence RC expression.
- Antidepressant drugs, particularly in women, may induce RC.
Conclusions:
- RC is a complex condition with multifactorial influences.
- Further research is needed to elucidate the roles of hypothyroidism and circadian rhythms.
- Clinical vigilance regarding antidepressant-induced RC is warranted.