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Bipolar Disord. 2017 Feb;19(1):6-12. doi: 10.1111/bdi.12462. Epub 2017 Feb 3.

Comparison of treatment outcome using two definitions of rapid cycling in subjects with bipolar II disorder.

Author information

1
Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
2
Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

OBJECTIVES:

We examined differences in treatment outcome between Diagnostic and Statistical Manual Fourth Edition (DSM-IV)-defined rapid cycling and average lifetime-defined rapid cycling in subjects with bipolar II disorder. We hypothesized that, compared with the DSM-IV definition, the average lifetime definition of rapid cycling may better identify subjects with a history of more mood lability and a greater likelihood of hypomanic symptom induction during long-term treatment.

METHODS:

Subjects ≥18 years old with a bipolar II major depressive episode (n=129) were categorized into DSM-IV- and average lifetime-defined rapid cycling and prospectively treated with either venlafaxine or lithium monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months.

RESULTS:

These exploratory analyses found moderate agreement between the two rapid-cycling definitions (κ=0.56). The lifetime definition captured subjects with more chronic courses of bipolar II depression, whereas the DSM-IV definition captured subjects with more acute symptoms of hypomania. There was no difference between rapid-cycling definitions with respect to the response to acute venlafaxine or lithium monotherapy. However, the lifetime definition was slightly superior to the DSM-IV definition in identifying subjects who went on to experience hypomanic symptoms during continuation therapy.

CONCLUSIONS:

Although sample sizes were limited, the findings suggest that the lifetime definition of rapid cycling may identify individuals with a chronic rapid-cycling course and may also be slightly superior to the DSM-IV definition in identifying individuals with hypomania during relapse-prevention therapy. These findings are preliminary in nature and need replication in larger, prospective, bipolar II studies.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00602537.

KEYWORDS:

antidepressant; bipolar disorder; depression; lithium; mania; mood stabilizer; rapid cycling; venlafaxine

PMID:
28160351
PMCID:
PMC5367974
DOI:
10.1111/bdi.12462
[Indexed for MEDLINE]
Free PMC Article

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