Course of the Manic-Depressive Cycle and Changes Caused by Treatments

Abstract

The course of 434 bipolar patients (256 women, 178 men) was studied longitudinally. The prevailing patterns of the manic-depressive cycles at the end of the observation time were: mania followed by depression (usually mild), 28%; depression followed by mania (usually hypomania), 25%; and continuous circular course, with long cycles, 19%, or with short (rapid) cycles, 20%. The cycles followed an irregular pattern in 8% of the patients.As to the intensity of the episodes, 52% of the patients had severe depressions and hypomanias; 26% had severe manias and mild depressions; and 22% had severe depressions and severe manias. No significant sex differences was found regarding the patterns of the cycles or the intensity of the episodes, except among the rapid cyclers, where women (61) outnumbered men (26).With time the course tended to change from monopolar to bipolar, and the frequency of recurrence increased. Concurrent treatments, expecially antidepressants, contributed to these changes, while fern ale sex, middle age and menopause, along with antidepressant drugs, contributed to the establishment of rapid cyclicity. The depression-hypomania course was the one which was most prone to rapid cyclicity.Response to lithium prophylaxis was good in the maniadepression-free interval course, in the continuous circular course with long cycles, and in the irregular course. It was less good in the depression-mania-free interval course, where it increased the frequency of recurrences, although these were shorter and milder. Response was very poor in the rapid cycling course. But rapid cyclers and patients with the depressionmania-free interval course responded weil to lithium when antidepressant drugs were not administered during the depressions.Verlauf des manisch-depressiven Zyklus und die durch Behandlung verursachten Veränderungen Der Verlauf der manisch-depressiven Zyklen bei 434 Patienten (256 Frauen, 178 Männer) wurde longitudinal untersucht. Die am Ende der Beobachtungszeit überwiegenden Verlaufsarten der manisch-depressiven Zyklen waren: Manie mit nachfolgender Depression (meist mild), 28%; Depression mit nachfolgender Manie (meist Hypomanie), 25%; kontinuierlich zyklischer Verlauf mit langen Zyklen, 19%; oder mit kurzen (schnellen) Zyklen, 20%. 8% der Patienten hatten Zyklen mit unregelmäßiger Verlaufsart. Hinsichtlich der Intensität der Episoden wurden folgende Beobachtungen gemacht: 52% der Patienten hatten schwere Depressionen und Hypomanien: 26% hatten schwere Manien und leichte Depressionen; 22% hatten schwere Depressionen und schwere Manien. Bei den Verlaufsarten der Zyklen oder der Intensität der Episoden gab es keine signifikanten geschlechtsspezifischen Unterschiede, mit Ausnahme der Patienten mit schnellen Zyklen, bei denen die Frauen (61) zahlenmäßig stärker vertreten waren als die Männer (26). Mit der Zeit bestand eine Tendenz zur Veränderung von monopolar nach bipolar und zu einer Zunahme der Häufigkeit von Rezidiven. Gleichzeitig vorgenommene Behandlungen, insbesondere mit Antidepressiva, trugen zu solche...

Continuous circular cycling in bipolar disorder as a predictor of poor outcome

“…Koukopoulos et al (1980) investigating the different patterns of manic depressive cycles, observed that 170 out of 434 bipolar patients (39%) had a course that did not include free intervals.…”

Memantine: New prospective in bipolar disorder treatment

“…Early reports of a possible link between this effect of antidepressants and the induction of a rapid cycling course of bipolar disorders were made by Kukopulos et al [26] and Wehr et al [27] . The term rapid-cycling bipolar disorder was coined by Dunner et al [28] in 1974 to identify lithium non-responders (further research has confirmed that rapid cycling is a factor of poor prognosis).…”

Rational Use of Antidepressant Drugs

“…These responses may reveal an unrecognized bipolar illness or may be drug induced, since they may also occur in allegedly unipolar patients. In the early 1980s, Kukopulos et al [29] observed how treatment with AD may contribute to changes in the course from unipolar to bipolar illness. They deserve credit for having raised the issue that AD-induced mania may not simply be a temporary and fully reversible phenomenon but may trigger complex biochemical mechanisms of illness deterioration.…”