Clinical aspects and treatment of rapid cycling mood disorders

Eight female patients with rapid cycling mood disorders (at least four discrete affective episodes per year) were examined from a clinical perspective. Assessment suggested several different etiologies to the rapid cycling pattern in these patients. These included that the rapid mood swings were: a natural expression of the affective disorder, tricyclic induced, a result of frequent medication changes and/or poor medication compliance, and a combination of the aforementioned etiologies. All patients were helped significantly with treatment. Treatment was individualized for each patient's unique illness and possible etiological factors in the rapid cycling. Treatment strategies and guidelines include: A psychotherapeutic approach involving the patient and his family which emphasizes the lengthy nature of treatment before expected results; The necessity of rigorous drug adherence, The sole use of "high dose" lithium therapy (greater than 1.2 MEQ/L) in some patients, and the consideration of "high dose" lithium in conjunction with tricyclics, MAO inhibitors or "adjuvant" medication in certain bipolar II patients; The discontinuation of tricyclics in bipolar rapid cyclers; The combination of lithium salts and carbamazepine or the use of carbamazepine alone in selected patients.