NotoriousBeef: Can bipolar behavior display itself in very quick high and lows? Like 20 minute intervals? An example: I have a friend who has a history of depression and is on Prozac. He recently visited me and he was elated, interested, and forthcoming for about 20 minutes at a time. Then he would become withdrawn and gloomy and sigh a lot in between those times. What's his problem?

In a word, yes. Bipolar disorders can cycle rapidly, even as rapidly as a 20 minute interval. This speed of cycling is uncommon, however, and is a sign of serious mood instability that deserves immediate psychiatric attention. The Prozac detail that you included from your friend's medical history is particularly relevant. But first, a brief historical digression that will help explain why antidepressant medication is an important element in understanding rapid cycling.

Thirty or forty years ago, antidepressant medication had not yet been developed. However, people suffering from manic depression (what we today call bipolar disorder) were well known to the psychiatrists of the time and were frequently hospitalized, either during the manic or the depressive phases of their illness. Then in the mid 1980s, an astute psychiatrist noticed that his depressed patients who were treated with tricyclic antidepressants such as Elavil (Prozac didn't exist yet) were appearing to switch into a manic phase after shorter and shorter intervals of depression. He conducted a very simple, yet wise, piece of research. He reviewed psychiatric hospital medical records from the 1930s and noticed that manic depressive patients in that era had mood cycles that lasted on average for about 12 to 18 months, not three months, or two weeks, or one day as he had been observing in his own practice. So why were some depressed patients who were receiving antidepressant medications starting to rapid cycle in ever shorter intervals in the 1980s? The psychiatrist accurately concluded that 1) the antidepressants were triggering a switch from depression to mania and 2) for some patients the switch in mood occurred with increasingly frequency over time. In the late 1980s, certain similarities were also noticed between bipolar disorders and the seizures suffered by people with epilepsy.

Psychiatrists began using anticonvulsant drugs to prevent rapid cycling in bipolar patients. Today, a handful of these drugs (carbamazepine or Tegretol, valproate or Depakote, gabapentin or Neurontin, and lamotragine or Lamictal) are used for just this purpose. And they have been renamed mood stabilizers or "anti-kindling" medications.

Your friend with the 20 minute cycles should be evaluated by a psychiatrist who is an expert in psychopharmacology. If he is indeed diagnosed as suffering from rapid cycling (or Bipolar II) disorder, he should be prescribed one of these mood stabilizers to complement his Prozac antidepressant treatment. Go to http://www.psycom.net/depression.central.drugs.html for more details.