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