Q:  Clinical Trials & Rapid Cycling

I have been struggling with ultra-rapid cycling bipolar disorder for years and in recent months it has gotten much worse.  I was hoping to learn about any clinical trials that might be appropriate for rapid-cyclers.

Thanks,
Liz
 

Dear Liz -- 
The research group at UCLA led by Dr. Whybrow is studying thyroid hormone as a treatment for rapid cycling.  Lamotrigine (Lamictal) has been shown to be effective in about 50% of a "treatment resistant" group of people with rapid cycling.  I would guess there are still some trials of lamotrigine underway looking at this further. 

As you probably know, there is strong agreement amongst mood experts that antidepressants can cause rapid cycling and that a routine step in rapid cycling should be to gradually (with your doctor's direct agreement and participation and guidance, if this is you we're talking about here...) lower the antidepressant (e.g. this case from Harvard). 

Otherwise, most current mood stabilizers have shown value in rapid cycling, with, in my view, the probable exception of risperidone due to its stronger -- relatively speaking -- antidepressant-like effects compared to other 2nd generation antipsychotics.  I am not aware of "rapid-cycling specificity" for other agents than those named, off the top of my head anyway. 

Dr. Phelps
 

Published December, 2003