Emerging trends in the treatment of rapid cycling bipolar disorder: a selected review.
Recent evidence suggests that lithium therapy (even as supplemented by antidepressants and neuroleptics) is inadequate for the majority of patients with bipolar illness, and particularly those with rapid cycling. Valproate and carbamazepine have emerged as adjuncts and alternatives, but they, too, often require additional approaches with lithium, thyroid hormones, and other putative mood stabilizers, including nimodipine (and related dihydropyridine calcium channel blockers), lamotrigine, gabapentin, topiramate, and the atypical neuroleptics. Evaluating how these agents and the unimodal antidepressants are optimally applied and sequenced in the treatment of bipolar illness with its multiple subtypes, patterns and comorbidities will require much future investigation and the development of new methodological clinical trial approaches.
Post
R M
RM
Biological Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, MD 20892-1272, USA.
Frye
M A
MA
Denicoff
K D
KD
Leverich
G S
GS
Dunn
R T
RT
Osuch
E A
EA
Speer
A M
AM
Obrocea
G
G
Jajodia
K
K
D000465:Algorithms; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003527:Cyclothymic Disorder / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D013375:Substance Withdrawal Syndrome
D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002121:Calcium Channel Blockers; D018020:Lithium Compounds