Rapid cycling bipolar disorder: Literature review on pharmacological treatment illustrated by a case report on ketamine

Introduction Rapid cycling bipolar disorder (RCBD) is defined as four or more affective episodes (depression, mania or hypomania) within 1 year. RCBD has a high point of prevalence (from 10% to 20% among clinical bipolar samples) and is associated with greater severity, longer illness duration, worse global functioning and higher suicidal risk, but there is no consensus on treatment option. The use of several pharmacological agents has been reported (levothyroxine, antipsychotics, antidepressants and mood stabilizers). Objective The main objective of this review was to propose a critical review of the literature and to rank the pharmacological agent using a level of evidence (LEO) adapted from the Center for Evidence-Based Medicine, and to illustrate it with a case report on off-label intravenous ketamine. Method We conducted a review using the MeSH terms and keywords (bipolar [Title/Abstract]) AND (rapid [Title/Abstract]) AND (cycling [Title/Abstract]) AND (treatment [Title/Abstract]). Alexis Bourla and Stephane Mouchabac screened 638 documents identified through literature search in Medline (PubMed) or by bibliographic references and 164 abstracts were then analyzed. Nonpharmacological treatments were excluded. Result Seventy articles were included in the review and divided into six categories: mood stabilizers, antipsychotics, hormonal treatments, ketamine and other pharmacological treatments. Discussion Our review highlights the heterogeneity of the pharmacological treatment of RCBD and no clear consensus can emerge.

Automated summary

The pharmacological treatment of Rapid Cycling Bipolar Disorder (RCBD) is heterogeneous and lacks a clear consensus. This review critically evaluates literature, excluding nonpharmacological treatments, and categorizes 70 articles into six categories, including mood stabilizers, antipsychotics, hormonal treatments, ketamine, and other pharmacological treatments.