Rapid Cyclers and Antidepressants

Abstract

434 bipolar manic-depressive patients were followed longitudinally. The course of the disease changed in many patients over the years. 67 cases became rapid cyclers (two or more cycles per year); in 40 of these cases (12 men and 28 women) the change of the course took place after intense or protracted use of antidepressant drugs. In their previous course these patients had not received antidepressant drugs. The common feature of the transformation of the previous course to a continuous circular one was the appearance for the first time in the course of the disease of hypomanie episodes after the depressions, or the accentuation of hypomanias that had been of milder intensity in previous recurrences. The patients who developed continuous circularity under antidepressant drug treatment were of highly energetic temperament. The hypothesis is advanced that these patients have latent hypomanias, which become clinically manifest under the action of antidepressants. The intensification of an underlying hypomanie process by the antidepressants would precipitate another depression and establish continuous circularity. The change to a rapid cyclical course was more frequent in middle-aged patients and in women.

Antidepressant-induced mania, rapid cycling and the serotonin transporter gene polymorphism

“…It has been suggested that there is a clinical link between rapid cycling and AIM. [9][10][11] The association that we observed between rapid cycling and the 5-HTTLPR may be related to the result obtained by Mundo et al Indeed, patients with rapid cycling may be over-represented among AIM(+) patients and under-represented among AIM(À) patients. Mundo et al only evaluated the presence of rapid cycling in the previous 12 months, whereas we considered the lifetime history of rapid cycling.…”

Memantine: New prospective in bipolar disorder treatment

“…According with clinical observations [46] D'Aquila et al [47,48] recently reported that the supersensitivity of dopamine receptors induced by antidepressants is followed, after 4 wk of imipramine discontinuation, by a reduced sensitivity of these receptors and a behavioural syndrome that mimics depression in humans. Antidepressant induced manic episodes in humans [38,41,49,50] and dopamine receptor sensitization should be considered not a mere iatrogenic phenomenon but the intensification of a spontaneous underlying hypomanic process.…”

Treated versus Untreated Major Depressive Episodes

“…There is no good data to support this assumption [3]. A further controversy was raised by the assumption that tricyclic antidepressants would increase the recurrence rate and therefore deteriorate the course [4]. When analyzing this question one has to bear in mind that in untreated cases the cycle length is also shortening with increasing number of episodes.…”