Question

What is bipolar disorder and what is rapid cycling disorder? How are they treated?

Answer

The term bipolar means those people who have both a depressive disorder and mania. It was formerly called manic depressive psychosis. More specifically, it is a psychiatric disorder featuring extreme alterations of mood from euphoria and hyperactivity to depression and apathy. There are two types of classification. One is the DMS IV and the other is the ICD X. The DSM IV separates bipolar disorder into:

bipolar I - in which mania has occurred on at least one occasion

bipolar II - where hypermania has occurred but mania has not

The lifetime risk for a bipolar disorder ranges from about 0.5% to 1.5%. The rates are significantly higher in urban areas. The average age of onset is 21 years. There is a definite genetic risk factor and first degree relatives have a risk of about 10% for a bipolar disorder.

For some types of bipolar depression, monoamine oxidase inhibitors may be more effective than other treatments. Lithium may also be more effective in bipolar patients than in those with unipolar depression. About 50% of bipolar patients respond well to lithium, while the rest show either no response or only a partial response. Lithium seems to be equally effective in preventing recurrences of depression and recurrences of mania. However, unfortunately a poor prophylactic response to lithium is associated with rapid cycling disorder. Carbamazepine can also be tried, especially in those who are intolerant of lithium, particularly those with rapid cycling disorder, who may benefit from carbamazepine given either alone or in combination with lithium.

The term "rapid cycling disorder" is used for particularly frequent recurrences of mood disturbance in bipolar patients. In these patients, there may be intervals of only weeks or months between episodes. These recurrent episodes may be depressive, manic or mixed. The main features are that the recurrence is frequent (conventionally at least 4 distinct episodes per year) and that episodes are separated by a period of remission or a switch to an episode of the opposite polarity. Rapid cycling disorders are much more common in females and may predict a poor response to lithium treatment. It is of practical importance that rapid cycling can sometimes be triggered by antidepressant medication.

Links

• Disease digest: Bipolar Disorder