Antidepressant-induced rapid cycling: another perspective

Depressive symptoms are the main cause of morbidity in bipolar patients, but concern about antidepressant-induced rapid cycling has limited antidepressant use in such patients. This paper evaluates the validity and the prevalence of antidepressant-induced rapid cycling.

The literature regarding antidepressant induced rapid cycling is reviewed, focusing on two issues: 1) does antidepressant-induced rapid cycling occur only in patients who become manic or hypomanic on antidepressants; 2) can the apparent shortening of cycle length on antidepressants be attributable simply to the fact that antidepressants alleviate depression and can precipitate mania or hypomania.

The suggestion that antidepressants can induce rapid cycling is derived primarily from patients who become manic or hypomanic on antidepressants. The fact that antidepressants alleviate depression and precipitate mania can explain most of the available data, without invoking the poorly defined concept of antidepressant-induced rapid cycling.

Bipolar patients who are stable on mood stabilizers, who don't become manic or hypomanic on anti-depressants, can be safely treated with antidepressants without excessive concern about inducing rapid cycling.