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A medication algorithm for treatment of bipolar rapid cycling?
J R Calabrese1, M J Woyshville
1Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106.
The Journal of Clinical Psychiatry
|January 1, 1995
Summary
Rapid cycling bipolar disorder is challenging to treat, with lithium often failing. Divalproex sodium and carbamazepine show promise, with specific patient factors predicting positive responses to divalproex sodium.
Area of Science:
- Psychiatry
- Neuroscience
- Pharmacology
Background:
- Rapid cycling bipolar disorder affects 13-20% of bipolar patients.
- Lithium, a common treatment, has high failure rates (72-82%) in rapid cyclers.
- This population is often treatment-refractory.
Purpose of the Study:
- To review treatment alternatives for rapid cycling bipolar disorder.
- To identify predictors of positive outcomes with divalproex sodium and carbamazepine.
- To propose a psychopharmacologic treatment algorithm.
Main Methods:
- Literature review of studies on divalproex sodium and carbamazepine for rapid cycling bipolar disorder.
- Analysis of predictors for treatment response.
- Discussion of current treatment recommendations and controversies.
Main Results:
- Divalproex sodium shows promise, with predictors for mania response including nonpsychotic, mild, or mixed states and stable/decreasing episode frequency.
- Predictors for antidepressant response to divalproex sodium include nonpsychotic mania, severe mania, and absence of borderline personality.
- Carbamazepine results are mixed, with some studies showing success in combination therapy, while others report no benefit.
Conclusions:
- Divalproex sodium and carbamazepine are potential alternatives for rapid cycling bipolar disorder.
- Predictive factors can guide divalproex sodium treatment decisions.
- Further research with randomized controlled trials is needed to confirm treatment recommendations.