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Whether antidepressants increase cycling in bipolar patients continues to be a controversial issue. To learn more, researchers gave fluoxetine to 167 depressed patients with bipolar II disorder; 25% had rapid cycling (defined as an annual average of ≥4 episodes over the course of illness).
Then, in a double-blind, controlled stage, 81 patients whose depression remitted (25 with histories of rapid cycling) were randomized to fluoxetine, lithium, or placebo for 50 weeks. The three treatment groups did not differ in rates of depressive relapse (29%, 35%, and 30%, respectively) or changes in mania ratings. Rapid-cycling and non–rapid-cycling patients did not differ in depressive relapse (36% and 52%, respectively) or emergent hypomania (44% and …