Cognitive-behavioral therapy for rapid cycling bipolar disorder

This article describes the application of cognitive-behavioral therapy (CBT) to the treatment of rapid cycling bipolar disorder. Between 10% and 24% of bipolar patients experience a rapid cycling course, with 4 or more mood episodes occurring per year. Characterized by nonresponse to standard mood-stabilizing medications, rapid cyclers are particularly in need of effective, adjunctive treatments. Adjunctive CBT has been shown to improve medication compliance and reduce relapse rates in patients with bipolar disorder. However, no published trials to date have examined the application of CBT to the treatment of rapid cyclers, with only a single case study existing in the literature. We address challenging clinical problems in the treatment of patients with rapid cycling bipolar disorder and include strategies for managing frequent mood fluctuations, medication compliance, sleep hygiene, lifestyle regularity, mood elevation, suicidality, and comorbidity. A case example is included to illustrate the treatment approach.