[Administration of high dose levothyroxine in treatment of rapid cycling bipolar disorders. Review of the literature and initial therapeutic application apropos of 6 cases]

Abstract

Introduction: Rapid cycling among bipolar disorders was characterized in 1974 by Dunner and Fieve by at least 4 episodes per year, lithium resistance, female predominance. The idea of using thyroid hormones is based on frequent coexisting thyroid dysfunction. Thyroid hormones where first used in the forties, and more recently (table I) in open label and blind trials (Stancer et Persad, 1982; Bauer et Whybrow, 1990).

Objective: Open label study of levothyroxine in rapid cycling bipolar disorder.

Material and methods: Six subjects (4 females and 2 males, mean age 45.5 years at onset of bipolar disorder) meeting DMS III-R criteria for rapid cycling bipolar disorder were consecutively included in an open label study of levothyroxine. Subject characteristics are presented in table II.

Results: After almost two years follow-up results appear positive in 67% of cases (2 complete remissions, 2 partial remissions and 2 failures).

Conclusion: Our cases, with data reported in the literature, support the potential efficacy of levothyroxine for treatment of rapid cycling bipolar disorder patients. We suggest a protocol for the good application of this potential new treatment (table III).