Korean J Psychopharmacol.  2004 Mar;15(1):44-50.

Korean Medication Algorithm for Bipolar Disorder(IV): Rapid Cycling

  • 1Department of Neuropsychiatry, Ilsan Hospital, National Health Insurance Corporation, Goyang,
  • 2Naju National Hospital, Naju, Korea.
  • 3Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.
  • 4Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea.
  • 5Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Korea.
  • 6Department of Psychiatry, College of Medicine, Catholic University, Seoul, Korea.


Treating rapid cycling bipolar disorder has many clinical problems such as recurrence, treatment resistance, and unstable course. Recent developments of medications including atypical antipsychotics and new anticonvulsants make it difficult to choose appropriate pharmacological options. The Korean Society of Psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder including rapid cycling to aid clinical decisions. METHODS: The first survey was performed with the questionnaire based on `The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000'. Because of inconsistency among experts in some aspects, we carried out the second survey and discussed with related literature to make a proper algorithm. RESULTS: Generally no `treatment of choice' were demonstrated. The first-line treatment is the single mood stabilizer or combination of a mood stabilizer and an atypical antipsychotic. Another mood stabilizer or an antidepressant can be added for the next treatment. Lithium, divalproex, and carbamazepine are preferred as a mood stabilizer than the third generation anticonvulsants. CONCLUSION: With the results of two surveys and discussion in executive committee, we developed the algorithm for rapid cycling bipolar disorder.


Bipolar disorder; Rapid cycling; Pharmacotherapy; Algorithm
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