[Administration of high dose levothyroxine in treatment of rapid cycling bipolar disorders. Review of the literature and initial therapeutic application apropos of 6 cases].
BACKGROUND
Rapid cycling among bipolar disorders was characterized in 1974 by Dunner and Fieve by at least 4 episodes per year, lithium resistance, female predominance. The idea of using thyroid hormones is based on frequent coexisting thyroid dysfunction. Thyroid hormones where first used in the forties, and more recently (table I) in open label and blind trials (Stancer et Persad, 1982; Bauer et Whybrow, 1990).


OBJECTIVE
Open label study of levothyroxine in rapid cycling bipolar disorder.


METHODS
Six subjects (4 females and 2 males, mean age 45.5 years at onset of bipolar disorder) meeting DMS III-R criteria for rapid cycling bipolar disorder were consecutively included in an open label study of levothyroxine. Subject characteristics are presented in table II.


RESULTS
After almost two years follow-up results appear positive in 67% of cases (2 complete remissions, 2 partial remissions and 2 failures).


CONCLUSIONS
Our cases, with data reported in the literature, support the potential efficacy of levothyroxine for treatment of rapid cycling bipolar disorder patients. We suggest a protocol for the good application of this potential new treatment (table III).
Afflelou
S
S
Laboratoire de Psychiatrie de l'Université Victor Segalen de Bordeaux II, Hôpital Charles-Perrens, Centre Carreire.
Auriacombe
M
M
Cazenave
M
M
Chartres
J P
JP
Tignol
J
J
D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy / Q000523:psychology; D008297:Male; D008875:Middle Aged; D013974:Thyroxine / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D018692:Antimanic Agents; D013974:Thyroxine