The case for and against selective serotonin reuptake inhibitors in rapid cycling bipolar disorder

Patients affected by the rapid cycling variant of bipolar disorder often experience significant functional difficulties. Physicians caring for affected patients face many challenges managing the turbulent course of this disorder, complicated at times by psychiatric comorbidities (including substance use disorders), polypharmacy, risk management (of suicidality and aggression), and difficulties with community functioning. There is some controversy about the use of selective serotonin receptor inhibitors (SSRIs) in managing bipolar depression, particularly in the rapid cycling variant. The potential benefit of SSRIs in reducing depressive symptoms must be balanced against the risks of mood phase switching and overall worsening of the rapid cycling course. This case report highlights challenges inherent in the application of SSRIs in a case of treatment-refractory rapid cycling bipolar disorder, and discusses the controversy of their use.