Comparison of treatment outcome using two definitions of rapid cycling in subjects with bipolar II disorder.
We examined differences in treatment outcome between Diagnostic and Statistical Manual Fourth Edition (DSM-IV)-defined rapid cycling and average lifetime-defined rapid cycling in subjects with bipolar II disorder. We hypothesized that, compared with the DSM-IV definition, the average lifetime definition of rapid cycling may better identify subjects with a history of more mood lability and a greater likelihood of hypomanic symptom induction during long-term treatment.



Subjects ≥18 years old with a bipolar II major depressive episode (n=129) were categorized into DSM-IV- and average lifetime-defined rapid cycling and prospectively treated with either venlafaxine or lithium monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months.



These exploratory analyses found moderate agreement between the two rapid-cycling definitions (κ=0.56). The lifetime definition captured subjects with more chronic courses of bipolar II depression, whereas the DSM-IV definition captured subjects with more acute symptoms of hypomania. There was no difference between rapid-cycling definitions with respect to the response to acute venlafaxine or lithium monotherapy. However, the lifetime definition was slightly superior to the DSM-IV definition in identifying subjects who went on to experience hypomanic symptoms during continuation therapy.



Although sample sizes were limited, the findings suggest that the lifetime definition of rapid cycling may identify individuals with a chronic rapid-cycling course and may also be slightly superior to the DSM-IV definition in identifying individuals with hypomania during relapse-prevention therapy. These findings are preliminary in nature and need replication in larger, prospective, bipolar II studies.
Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jay D
JD
Amsterdam
Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
Lorenzo
0000-0002-8882-0243
L
Lorenzo-Luaces
Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
Robert J
RJ
DeRubeis
D000328:Adult; D000339:Affect / Q000187:drug effects; D000928:Antidepressive Agents / Q000008:administration & dosage*; D018692:Antimanic Agents / Q000008:administration & dosage; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010507:Periodicity; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D018692:Antimanic Agents
antidepressant; bipolar disorder; depression; lithium; mania; mood stabilizer; rapid cycling; venlafaxine