Background: Rapid cycling (RC) bipolar disorder is often
treatment-resistant to pharmacotherapy. Non-pharmacological methods,
however, are reasonable considerations in treatment refractory cases of
bipolar patients. Thus, such methods may be useful in the management of
RC, especially when drugs are not shown to be effective.
Method: This review is based on studies of all major non-pharmacological
methods which are used in the management of bipolar disorder, by
focusing on data regarding patients with a RC pattern of the illness.
Results: Regarding biological treatments, for electroconvulsive therapy
and sleep deprivation, there exists some evidence that they might be
efficacious in RC patients for acute treatment as well as for
prophylaxis from recurrences. Light therapy has not been shown to be
efficacious in RC, while no published data exist for transcranial
magnetic stimulation and vagus nerve stimulation. The non-biological
treatments include psychotherapeutic and psychosocial interventions;
these have not been tried particularly on RC patients, but their use
should be expected to contribute to the overall management of the RC
pattern as it does to that of mood disorder in general.
Limitations: Many data on which this review is based are drawn from case
reports or non-randomised trials.
Conclusions: Non-pharmacological methods, either biological or
non-biological (psychotherapies and psychoeducation), may be applied in
the management of RC patients. These methods might be used in
combination with the administration of drug treatment, based on the
clinical experience of the physician and the individual characteristics
of the patient. (c) 2006 Elsevier B.V. All rights reserved
