Nimodipine treatment of an adolescent with ultradian cycling bipolar affective illness

This is a single case report of an open trial of nimodipine, a dihydropyrid ine-type calcium antagonist, in the treatment of a 13-year-old boy with ref ractory, ultradian rapid cycling, bipolar disorder type I. Prior clinical t rials with calcium channel blockers in adults with ultrarapid cycling affec tive disorder supported an empirical trial of nimodipine for treatment of u ltradian rapid cycling in this adolescent. Severity of mania and depression were rated before and after nimodipine therapy. A marked decrease in rapid , repeated, and significant mood changes was clinically observed and measur ed by standardized scales after 9 days of nimodipine 180 mg daily. No adver se effects were noticed. Remission persisted with continued treatment at 36 -month follow-up. Medication response was partially attributed to adjunctiv e therapy with levothyroxine. Implications of treatment benefit are discuss ed in the context of novel pharmacotherapies for refractory bipolar disorde r. These findings are preliminary and do not provide sufficient basis to re commend nimodipine as the treatment of choice in adolescents with ultradian cycling bipolar disorder, but suggest that controlled studies may be indic ated.