Rapid cycling in Bipolar Disorder is defined by DSM-5 as at least how many mood episodes per year, and which pharmacological agent is notorious for precipitating or worsening rapid cycling?

• A 2 or more mood episodes per year; valproate
• B 4 or more distinct mood episodes per year; antidepressants (particularly TCAs) ✓
• C 6 or more mood episodes per year; lithium
• D 4 or more mood episodes per year; antipsychotics

Explanation

Rapid cycling is defined as 4 or more distinct mood episodes (manic, hypomanic, mixed, or major depressive) per 12-month period, separated by partial or full remission for at least 2 months or by a switch to an episode of opposite polarity. It affects approximately 10–20% of bipolar patients and is associated with poorer prognosis. Antidepressant use — particularly tricyclic antidepressants — can precipitate or maintain rapid cycling by inducing mania/hypomania or cycle acceleration. Current guidelines recommend minimising or avoiding antidepressants in rapid cycling and optimising mood stabiliser therapy (lithium, valproate, lamotrigine).

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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