Now: Do any other drugs cause rapid cycling or destabilize/accelerate the cycles?
Yes. In one study, people who were manic/mixed with and without rapid cycling (unspecified type) were given Zyprexa (olanzapine), and followed for one year. Those who had rapid cycling got MORE episodes of depression and had MORE cycle acceleration than the people on Zyprexa who were not rapid cycling. So Zyprexa accelerates cycles and detabilizes the underlying illness for people with rapid cycling. It is not known whether Zyprexa is any different from Seroquel (quetiapine), Geodon (ziprasidone), Risperdal (risperidone), or any other atypical antipsychotic drugs (AAPDs); more studies are needed.
It was always very clear to old-time psychiatrists that old antipsychotic drugs (APDs) made people depressed. Now, everybody believes that the new atypicals (AAPDs) are so much better: that they do not cause as much tardive dyskenesia, and that they seem to improve cognition.
But these new AAPDs can cause diabetes, high cholesterol, high tryglycerides, more heart disease, insulin resistance and obesity. So these drugs are not better than the old drugs: they just cause different severe problems. In any case, the Zyprexa study shows that at least one of these newer drugs may cause depression and accelerated cycles in people with rapid cycling.
Another important issue: many of these drugs can CAUSE adverse harmful effects (side effects) which seem exactly like the symptoms of the underlying illness. When this happens, the drug has caused the exacerbation of the symptoms, but everybody thinks that the illness has got worse, and you get more drugs.
In other words, antidepressants and antipsychotic drugs can sometimes cause agitation, anxiety, a "jumping out of your skin" feeling, suicidality, depression, mania and many more adverse mood effects. You can also have exacerbation of problems when going up or going down on doses. This is why you must write down the drugs, doses, etc. every day, so you can figure out if worsening of episodes is associated with drugs. Of course, this is hard; you are often taking so many drugs, they may "kick in" differently, etc. No matter how difficult, you must write down these things: you will not remember them in detail.
In all of medicine, it is well recognized that drugs interact with each other, and it is better to be on as few drugs as really necessary. In psychiatry, this does not seem to be true: they believe that more drugs are better. I am not antipsychiatry: I take drugs and see a wonderful psychiatrist and therapist. I just want some good drugs, and good research.
Do you realize that there have been no drugs specifically developed for bipolar disorder? Antidepressants were developed for depression, antipsychotics for schizophrenia and antiepileptic drugs - used as mood stabilizers - for epilepsy. They were then all imported into treating bipolar disorder. Lithium is the one drug that is specifically used as a mood stabilizer to treat bipolar disorder; Symbyax was recently approved expressly to treat bipolar depression, but it is a combination of drugs that were developed for treating other conditions. No wonder we have such a hard time finding a drug that works!
Editor's Note: In the fall of 2003, Drs. Tillman and Geller from the Washington School of Medicine, St. Louis, Missouri, proposed a change in terminology to help clarify the confusion caused by rapid cycles and episodes. They suggest that in the cases of ultra-rapid and ultradian cycling, cycles would be determined by mood switches occurring daily or every few days during an episode, and that an "episode" should be defined by "(a) the duration from onset to offset of a period of at least 2 weeks in length during which only one mood state persists or (b) the duration from onset to offset of a period of ultrarapid or ultradian cycling for at least 2 weeks."
This certainly would make it easier - if you could say "I had a two-week long episode of ultra-rapid cycling where my mood switched at least once every two days and sometimes more often," instead of having to keep perfect count so you could say "I had 6 hypomanic and 5 depressive episodes over a period of 14 days of ultra-rapid cycling." Not to mention how much easier it would be for parents whose bipolar children can switch moods several times a day!
