BACKGROUND: Rapid cycling among @entity1 with @entity162 is important because of its implications for long-term prognosis and for the use of antidepressants. To our knowledge, no prospective study has, as yet, described the course of this phenomenon beyond 5 years. METHODS: From 345 @entity1 with @entity162 or @entity162 followed up for a mean (SD) of 13.7 (6.1) years as part of the National Institute of Mental Health Collaborative Depression Study, 89 (25.8%) were identified who, during 1 or more years of follow-up, manifested a pattern that met DSM-IV criteria for rapid cycling. These @entity1 were compared with the remaining @entity162 @entity1 by demographics, overall affective morbidity, morbidity during specific treatment conditions, and the likelihood of suicidal behavior. Analyses assessed whether the use of tricyclic antidepressants for @entity308 symptoms was associated with the persistence of rapid cycling or with tendencies to switch from @entity308 to @entity162 or hypomanic phases. RESULTS: The 89 @entity1 who showed a rapid cycling pattern were significantly more likely to have had an illness onset before 17 years of age and were more likely to make serious suicide attempts. In 4 of 5 cases, rapid cycling ended within 2 years of its onset. Resolutions were not associated with decreases in tricyclic antidepressant use. Throughout follow-up, @entity1 prone to rapid cycling experienced more @entity308 morbidity than other @entity162 @entity1 , particularly when @entity3486 was being used without tricyclic antidepressants. The use of these antidepressants was not more likely in the weeks preceding shifts from @entity308 to @entity162 or hypomania. CONCLUSIONS: These results indicate that @entity162 @entity1 who develop a rapid cycling pattern suffer substantial @entity308 morbidity and are at high risk for serious suicide attempts. These findings do not implicate tricyclic antidepressants or, by inference, @entity750 reuptake inhibitors in the promotion of affective instability.

The long-term course of rapid-cycling XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity162 :: ('MESH:D001714', 'Disease') :: ['manic', 'bipolar affective disorders', 'bipolar I', 'bipolar II disorder', 'mania', 'bipolar'] @entity308 :: ('MESH:D003866', 'Disease') :: ['depression', 'depressive'] @entity3486 :: ('MESH:D016651', 'Chemical') :: ['lithium carbonate'] @entity750 :: ('MESH:D012701', 'Chemical') :: ['serotonin']
@entity162 :: (MESH:D001714,Disease) :: ['bipolar disorder']
