he article by Coryell et al is an important contribution to the literature on rapidly cycling affective disorder. Of particular benefit is the precise definition of the disorder being offered by that group. However, the article did not disclose any data on the relationship between pregnancy and rapid cycling. It had been observed that rapidly cycling bipolar patients who benefit from hypermetabolic doses of thyroxine tend to be females whose rapid cycling occurs shortly after pregnancy.1 High doses of levothyroxine sodium remain a useful adjunctive treatment in rapidly cycling affective disorder,2 as the following case illustrates.
Report of a Case.
A 36-year-old woman presented with a 9-year history of rapidly cycling bipolar affective disorder. The rapid cycling began shortly after the birth of her only child, and she experienced changes in her mood from mania to depression every 2 to 3 weeks with no intervening periods of euthymia.