Bipolar disorder is a mental disorder that causes drastic shifts in mood, energy, activity levels, memory, and concentration, and impacts the ability to carry out daily tasks. This disorder presents itself in various stages and is categorized into three types: Bipolar 1, Bipolar 2 and Cyclothymic Disorder. The episodes of mania and depression are generally treated with a combination of medication and talk therapy. Sometimes symptoms are severe enough to warrant inpatient hospitalization.
What Are Bipolar Cycles?
Bipolar cycles refer to someone with bipolar disorder cycling through the stages of mania and depression. Depending on which type of bipolar disorder the person has, these stages may be cycled through within days or weeks, or last for years. With the right treatment plan, a person may be able to limit their bipolar cycles to experiencing symptoms instead of full-blown stages.
Manic Episodes
All three types of bipolar disorder include periods of mania or hypomania. With Bipolar 1 these episodes last at least seven days, with bipolar 2 these symptoms are not as full blown, and with cyclothymia these symptoms last at least two years.
People experiencing a manic episode may exhibit the following:
- Feelings of being very “high” or elated
- Decreased need for sleep
- Loss of appetite
- Increased rate of speech
- Racing thoughts
- Engaging in risky behaviors such as high risk sex or excess spending
- Feeling invincible and that they can do anything
A person in the throws of a manic episode may exhibit behavior that is unusual or unrecognizable to their peers and family. The person is also unable to recognize the shift and may simply insist that they are just feeling great or are exuding the best version of themselves.1
Depressive Episodes
A person with bipolar disorder will experience a depressive episode, generally directly following a manic episode. This shift will often look like a crash.
Someone with bipolar disorder experiencing a depressive episode may exhibit the following:
- Feelings of sadness, emptiness, or hopelessness
- Restlessness or a slowed down feeling
- Trouble falling asleep or sleeping too much
- Increased appetite and weight gain
- Slow speech and forgetting what they have to say
- Inability to carry out even simple tasks
- Little interest in activities and anhedonia (the inability to experience pleasure)
- Increased thoughts of death or suicide
A person experiencing a depressive episode may retreat within themselves and temporarily cut off contact with the people in their life. In some cases this isolation can play a role in job loss, loss of relationships, and, in extreme cases, suicide.1
Mixed Features
Some people experience symptoms of mania and depression simultaneously, which is called an episode with mixed features. This presentation will look like a combination of the symptoms listed above (e.g., feeling empty and hopeless but extremely energized).
How Often Do People With Bipolar Disorder Cycle Through the Stages?
The duration of these cycles present differently in each individual, and the length of each cycle varies depending on the diagnosis. A large influence on how long the cycles may last depends on how engaged an individual is in treatment. People who follow a steady regimen are more likely to experience symptoms and less likely to experience a full episode of either depression or mania. However, because treatment is so nuanced with this particular disorder, managing these cycles is a lifelong struggle.
What Triggers a New Bipolar Cycle?
Many times a major stressful event, either experienced in late adolescence or early adulthood, can be the start of someone’s bipolar cycle. Drugs and alcohol can also trigger an initial manic episode, and those who have a genetic disposition to the disorder are encouraged to be cautious when using substances.
In addition, one of the main things that triggers a new cycle is the individual’s noncompliance with treatment, specifically medication. Many people with bipolar disorder feel that medication will “dull” them too much and this leads to decreasing dosage or stopping altogether. Additionally, some individuals will stop medication because they feel “better” and think that they can continue to control their symptoms on their own. More often than not, stopping medication will lead to a manic episode—and sometimes hospitalization.2
Rapid-Cycling in Bipolar Disorder
Bipolar 1, or rapid-cycling bipolar disorder, involves dramatic mood swings and is very recognizable to family and loved ones. The disorder is characterized by a person having a manic episode and then shifting to hypomania (less severe symptoms), followed by a major depressive episode lasting at least two weeks.
Bipolar 1 is diagnosed at the onset of the manic episode, and the person needs to be experiencing at least three manic symptoms (e.g., grandiosity, lack of sleep, fast speech, increased risky behavior, or racing thoughts). The diagnosis is further supported when a person experiences a major depressive episode.
A major depressive episode is characterized by having at least five of these symptoms (and always including the first two):
- Intense despair or hopelessness
- Loss of interest in activities
- Increased sleep
- Restlessness
- Slowed speech
- Loss of energy and extreme fatigue
- Frequent thoughts of death or suicide
People with rapid cycling bipolar disorder also generally experience other mental disorders such as attention deficit hyperactivity disorder (ADHD), anxiety disorder or a substance misuse disorder.2
Treating Bipolar Disorder
Treating bipolar disorder involves either medication alone or a combination of talk therapy and medication. Each person’s treatment is individualized and tailored to their specific symptoms. A person may likely need to try multiple medications before finding the one that works best for them.
Mood stabilizers and antipsychotics are generally used to treat bipolar disorder. Providers will generally prescribe an antidepressant as well as a mood stabilizer to prevent the antidepressant from triggering a manic episode. It is important that people taking medication are consistent and do not suddenly stop; suddenly stopping can lead to a worsening of symptoms.
Talk therapy along with medication can be very helpful and often entails a lot of psychoeducation around the disorder and ways in which to manage day to day. Cognitive behavioral therapy (CBT) specifically has proven to be very helpful.3
Final Thoughts on Bipolar Cycles
If you or a loved one are dealing with bipolar disorder, your issues are specific to you, but you’re not alone. Connecting with a skilled therapist can make a big difference in how you feel. Having a space in which to process through some of the challenges that you may face living with bipolar disorder can provide you with a sense of relief.
