How to Minimize Cycling/Switching in Patients with Bipolar Disorder

Bipolar disorder affects approximately 2% to 3% of the population and is the sixth leading cause of disability worldwide. A naturalistic study of patients with a first hospitalization for mania or a mixed episode, published by Tohen et al [1], found that 50% recovered from the acute symptoms within six weeks and 98% within two years. The same study also found that about 40% of patients experienced a new episode of depression or mania within two years of recovery, while 19% of patients switched phases without inter-episode recovery.

On average, patients with bipolar disorder may suffer a mood episode every 2 to 2.5 years. Rapid cycling bipolar disorder is defined by a patient having four or more mood episodes in a 12-month time span. Over the past several years, there has been more concern over the association between the use of antidepressant medications and an increased risk of more frequently cycling or switching of mood episodes. Some guidelines now recommend against the use of antidepressants in patients with bipolar disorder, as some studies have failed to show any long-term benefit from their use.

Perhaps one of the more consistent triggers for mood switching/cycling is sleep disturbance. Insomnia or significantly reduced sleep time can be both a trigger for and sign of impending mood switching. There is also literature supportive of the claim that use of cannabis and alcohol can increase the risk of cycling and the frequency of mood switches [2,3].

In my practice, my typical strategy to minimize mood cycling/switching in patients with bipolar disorder includes educating patients and families about:

 (1) The importance of consistent medication adherence.

 (2) The importance of paying attention to sleep quality and quantity.

 (3) The potential impact of the use of alcohol and drugs on patients’ vulnerability to exacerbation of their symptoms.

What strategies to do you use in your practice to minimize mood cycling/switching?

References

1. Tohen M, Zarate CA Jr, Hennen J, et al. The McLean-Harvard First-Episode Mania Study: Prediction of recovery and first recurrence". Am J Psychiatry. 160(12): 2099–2107.

2. Bally N, Zullino D, Aubry M. Cannabis use and the first manic episode. J Affect Disord. 2014;165: 103-108.

3. Nery FG, Miranda-Scippa A, Nery-Fernandes, et al. Prevalence and clinical correlates of alcohol use disorders among bipolar disorder patients: results from the Brazilian Bipolar Research Network. Compr Psychiatry. 2014;55(5): 1116-1121.

Chris Bojrab, MD, is the president of Indiana Health Group, the largest multidisciplinary behavioral health private practice in Indiana, established in 1987. He is a board certified psychiatrist and a Distinguished Fellow of the American Psychiatric Association who treats child, adolescent, adult, and geriatric patients. His areas of interest include psychopharmacology, sleep disorders, and gambling addiction. For more information and disclosures, visit  www.chrisbojrabmd.com

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.