Treating rapid cycling bipolar disorder with novel medications

Background: Brief definition of rapid cycling is the occurrence of at least four mood episodes in a year. It may be seen in patients with bipolar I, or bipolar II disorder. Rapid cycling bipolar disorder is frequently treatment-resistant. There is need for new, effective medications for the treatment of these patients. Objective: Novel anticonvulsants and newer generation of atypical antipsychotics may offer promising alternative treatment to existing mood stabilizers and other medications available for rapid cycling bipolar patients. Method: A computerized (MEDLINE) search was performed to explore the English-language literature on medications that were studied in patients with rapid cycling bipolar disorder. Bipolar disorder and rapid cycling were used as key words while performing the search. The articles, including in press ones were then searched. Results: Lithium has been a predictor of poor response to rapid cycling in earlier studies, while recent studies have demonstrated equal efficacy of lithium, and valproate. In fact, many available medications are not effective in rapid cycling patients. Lithium, lamotrigine and valproic acid and combination of mood stabilizers are likely the most efficacious treatment regimens among all. Efficacy of atypical antipsychotics in combination with mood stabilizers is noted, but this finding has not been consistent across studies. Conclusions: Combination of mood stabilizers might be more effective than use of other treatment regimens in patients with rapid cycling bipolar disorder. There is need for controlled studies evaluating the efficacy of combinations with different mood stabilizers to establish better treatment approaches.