Current concepts in rapid cycling bipolar disorder.

Rapid cycling bipolar disorder (RCBD) has remained a marker for high recurrence risk and resistance to conventional somatic treatments. RCBD continues to be diagnosed disproportionately in women and those with bipolar II disorder, and its time of onset may be in childhood, adolescence, or adulthood. Although by definition RCBD is a biphasic illness, depressive symptoms appear to predominate and remain the more difficult symptoms to treat. Recent studies with lamotrigine demonstrate at least partial efficacy in RCBD, particularly in the depressed phase, and early investigations using second-generation antipsychotics show promise. Use of antidepressants is discouraged. Combination therapy using mood stabilizers or mood stabilizers plus second-generation antipsychotics is likely for adequate control, although controlled trials in homogeneous cohorts of RCBD patients are needed.