Rapid Cycling Bipolar Disorder Associated With ADHD and Female Gender

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Patients with a history of ADHD are 4.6 times more likely to manifest a rapid cycling course.
Patients with a history of ADHD are 4.6 times more likely to manifest a rapid cycling course.

A history of attention deficit hyperactivity disorder (ADHD) and being female increases the risk for rapid cycle bipolar disorder, according to a study published in the Journal of Affective Disorders.

Researchers examined clinical characteristics differentiating rapid cycling and non-rapid cycling bipolar disorder. Patients from the Bipolar Disorders Unit at Red de Salud UC-Christus hospital (N=235) were evaluated for sociodemographic data, clinical reports, specifiers of bipolar disorder, and current therapies.

The total sample included 63% women, 64% diagnosed with bipolar disorder type I, 35% diagnosed with bipolar disorder type II, and 1% diagnosed with bipolar disorder not otherwise specified. Patients were classified according to rapid cycling bipolar disorder (18.7%), defined as experiencing at least 4 mood cycles in the previous year, or non-rapid cycling bipolar disorder (81.3%). Rapid cycling bipolar disorder was more common among patients who were female (81.4%, P =.006) and type II bipolar disorder (58.1%, P =.002), an earlier age of onset (19.8 years, P =.063), more affective episodes (88 ± 12.7, P =.003), more manic/hypomanic episodes (43.6 ± 35.8, P =.001), and with lower psychotic symptoms (20.9%, P =.01). ADHD was significantly predominant in rapid cycling bipolar disorder (23.7%, P =.007). Logistic regression indicated that being diagnosed with ADHD increased the chances of rapid cycle bipolar disorder 4.6 times (odds ratio 4.6; 95% CI, 1.54–13.93; P =.006) and being female increased the chances of rapid cycle bipolar disorder 3.6 times (odds ratio 3.55; 95% CI, 1.32–9.56; P =.012).

Future prospective research needs to examine the long-term effects of time, potential biological markers to aid with diagnoses, and treatment plans for refractory disorders. 

The study researchers suggest an association between ADHD, being female, and rapid cycling bipolar disorder, concluding, “clinicians should carry out careful diagnostic assessments in order to point out possible areas of interventions for comorbidity.”

This study was supported by the CONTCYT PIA ACT1414; FONDECYT 1160736, 1180358, and a Research Grant from Clínica Alemana de Santiago. Please refer to reference for a complete list of authors' disclosures.

Reference

Aedo A, Murru A, Sanchez R, Grande I, Vieta E, Undurraga J. Clinical characterization of rapid cycling bipolar disorder: Association with attention deficit hyperactivity disorder. J Affect Disord. 2018;240:187-192. doi: 10.1016/j.jad.2018.07.051

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