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Clinical and Research News
Rapid-Cycling Patients Show Earlier Age of Onset
Psychiatric News
Volume 39 Number 20 page 23-23

It's a turbulent roller coaster ride for many bipolar patients—frequent swings between a normal mood, depression, and mania. Yet what types of bipolar patients become these "rapid cyclers"?

Some insights have emerged from a multicenter study funded by the National Institute of Mental Health that was launched several years ago and is purportedly the largest long-term study of the course and outcome of bipolar disorder ever undertaken (Psychiatric News, April 20, 2001).

The findings are reported in the October American Journal of Psychiatry.

The study is called the Systematic Treatment Enhancement Program for Bipolar Disorder. The goal is to enroll 5,000 patients in it. However, data from the first 500 patients enrolled in the program have been used to obtain insights into rapid cyclers. Here are some of the major findings culled from those data:

"Probably the result that surprised us most was the association between rapid cycling and younger age of onset of bipolar illness," Christopher Schneck, M.D., an associate professor of psychiatry at the University of Colorado Health Sciences Center and the lead investigator in this arm of the study, told Psychiatric News. "Many previous studies had found rapid cyclers to be older than non-rapid cyclers.... The finding makes us wonder if young age of onset is a risk factor for developing rapid cycling."

One of the study results that Gary Sachs, M.D., director of the bipolar clinic and research program at Massachusetts General Hospital and the principal investigator of the entire Systematic Treatment Enhancement Program, would like to highlight is the controversial issue of gender in rapid cycling.

"We've gotten results that are similar to other studies that have done it right," he said, "and I think we're proud of that."

"All in all," he added, "I think we have shown that this is a particularly pernicious and relatively common form of bipolar disorder that deserves to be a subject of research in its own right."

Schneck concluded, "I think the implications of the study for clinical psychiatrists are perhaps to be more suspicious of `rapid-cycling potential' in those patients who experienced early onset of the illness. This may then have implications in being more cautious in using antidepressants, as these patients may be even more vulnerable to cycling."

The study, "Phenomenology of Rapid-Cycling Bipolar Disorder: Data From the First 500 Participants in the Systematic Treatment Enhancement Program," is posted online at<http://ajp.psychiatryonline.org/cgi/content/full/161/10/1902?>.

Am J Psychiatry20041611902

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