Rapid switching of mood in families with familial bipolar disorder

Evaristus A. Nwulia, Peter P. Zandi, Melvin G. McInnis, J. Raymond DePaulo, Dean F. MacKinnon

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective: Rapid switching of moods in bipolar disorder has been associated with early age at onset, panic comorbidity, and suicidality. This study aims to confirm these associations and investigate other potential correlates of rapid switching of mood using families from a multisite bipolar linkage study. Methods: The subjects were comprised of 1,143 probands and relatives with diagnosis of bipolar disorder. All subjects were interviewed directly with a standard diagnostic instrument, and all subjects who met criteria for bipolar disorder were asked if their moods had ever switched rapidly. Results: Individuals with rapid mood switching had significantly earlier age at onset (18 versus 21years, p < 0.00001), higher comorbid anxiety (47% versus 26%, p < 0.00001) and substance use disorders (52% versus 42%, p = 0.0006), higher rate of violent behavior (6% versus 3%, p < 0.004), suicidal behavior (46% versus 31%, p < 0.00001), and nonsuicidal self-harm (13% versus 6%, p < 0.0002). Multiple logistic regression analysis found significant net effects on rapid mood switching for early emergence of symptoms [odds ratio (OR) = 0.62; 95% confidence interval (CI): 0.45-0.85]; anxiety comorbidity (OR = 2.31; 95% CI: 1.34-3.98); and hypersensitivity to antidepressants (OR=2.05; 95% CI: 1.49-2.83) as the strongest predictors. Conclusions: This confirms earlier reports associating rapid switching with a more complex clinical course, in particular early emergence of bipolar symptomatology, antidepressant activation, and anxiety comorbidity. These results support a clinical differentiation of bipolar disorder into subtypes based on symptom stability.

Original languageEnglish (US)
Pages (from-to)597-606
Number of pages10
JournalBipolar Disorders
Issue number5
StatePublished - Aug 2008


  • Antidepressant activation
  • Bipolar disorder
  • Bipolar linkage
  • Comorbidity
  • Rapid cycling
  • Rapid switching of mood

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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