Rapid cycling from antidepressants (was: Part II: Hanky-Panky.....)

Alan J. Robinson robin073 at maroon.tc.umn.edu
Sat Sep 23 09:36:54 EST 1995

On Fri, 22 Sep 1995 19:33:53 -0400, 
J Thompson  <jet14 at columbia.edu > wrote:

>In article <43u2ol$lrr at linda.teleport.com>, jwood at teleport.com (Bret and
>Jill Wood) wrote:
>> In article <pproctor.471.002965F3 at sam.neosoft.com>,
>> Peter H. Proctor <pproctor at sam.neosoft.com> wrote:
>> >
>> >References ?   Not about the mania, which I will accept, but that it is made 
>> >irreversible by the SUI.
>> Since you are willing to take my word that SSRI's can cause manic episodes
>> and rapid-cycling in bipolars (because it makes sense), yet you ask for
>> references on my other point, I assume your request for references was 
>> based on an assumption that my statements come from my interpretations of
>> personal experiences and anecdotal evidence from others I have talked to.

"Rapid cycling" in the context of manic depression refers to mood 
swings that take place more frequently than about once per year.  This 
type of rapid cycling usually requires carbamazepine augmentation.

There are also mood swings of shorter period - see the chart 
on p. 649 of FK Goodwin & KR Jamison.  "Manic-Depressive Illness". OUP 
1990.  Antidepressants can precipitate several different types of mood 
swings - some reversible, some not.  The permanent conversion of 
Bipolar II disorder to Bipolar I disorder by treatment has been termed 
Bipolar III disorder, but the term hasn't caught on, possibly because 
some might prefer that attention not be drawn to this phenomenon.

Bipolar II disorder is very difficult to diagnose - most people suffer 
from mood swings to one extent or the other.  In fact, the conversion 
to mania after starting an antidepressant may be the first indication 
that there is something amiss.  Bipolar II disorder may be very 
common - the real surprise is that more patients don't experience 
manic attacks on antidepressants.

Even though a manic attack is pretty awful, it's not necessarily a bad 
thing in the long run - patients on lithium are often better off than 
those taking antidepressants, experiencing fewer side effects and 
residual symptoms.  The challenge to medicine is to come up with a 
CURE for manic depression rather than a treatment, so that one doesn't 
have to take lithium for the rest of one's life.


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