General principles in the pharmacotherapy of antidepressant-induced rapid cycling: a case series

The treatment of depression in patients who rapidly cycle once they receive antidepressant medication is a difficult clinical problem. Hurowitz and Liebowitz presented six patients with antidepressant-induced rapid cycling and proposed guidelines for how to manage medications in these patients. In this article, we present six new cases of antidepressant-induced rapid cycling as well as follow-up from four of the previous cases. We conclude that DSM-IV criteria are not sufficiently sensitive to diagnose antidepressant-induced rapid cycling and that the treatment guidelines of Hurowitz and Liebowitz, although not foolproof, are useful. General recommendations for treating patients with antidepressant-induced rapid cycling are discussed.