Rapid Cycling of Bipolar Patients

Athanasios Koukopoulos, G. Serra, F. Zazzara, A. E. Koukopoulos, G. Sani

Research output: Chapter in Book/Report/Conference proceedingChapter


Rapid cyclers (RCs) defined as those patients who have at least four affective episodes in a year were rare in the past, as the prepharmacological psychiatric literature shows, and have become increasingly more frequent since the introduction of antidepressant treatments. Ultra-rapid and ultradian rapid cycling is also seen frequently today. The RC course is more frequent in women than in men and bipolar II is more frequent than bipolar I type. The data about the persistence of the RC course are contrasting in the literature. Among our patients, however, the RC course has lasted for many years in more than 50% of them. An important clinical feature of RC, one that made possible their identification by Dunner and Fieve in 1974, is their refractoriness to mood-stabilizing treatments. The authors consider the absence or the extreme shortness of free intervals the cause of this refractoriness. The withdrawal of antidepressant drugs and the use of the most efficacious mood stabilizers including antipsychotic drugs are the basis of the pharmacological treatment. A preliminary naturalistic study with Memantine has yielded promising results.

Original languageEnglish
Title of host publicationBipolar Psychopharmacotherapy: Caring for the Patient: Second Edition
PublisherJohn Wiley and Sons
Number of pages12
ISBN (Print)9780470747216
Publication statusPublished - Apr 13 2011


  • Clinical Picture of Rapid Cycling
  • Epidemiological Data
  • Rapid cyclers (RCs)
  • Rapid Cycling of Bipolar Patients
  • Spontaneous and Induced Rapid Cycling

ASJC Scopus subject areas

  • Medicine(all)


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