Rapid-cycling bipolar disorder is one of the more severe forms of bipolar disorder, as it can seriously impair a person’s ability to function and impede their overall quality of life. The term generally applies to those who go through four or more episodes (i.e., mood swings) within a year. These episodes may entail symptoms of depression, mania, and hypomania.
What Is Rapid Cycling?
The mood swings associated with rapid-cycling bipolar disorder are generally unpredictable. They can last anywhere from a week to a few months. Rapid cycling is also not considered a formal diagnosis but rather a characterization of the course the illness takes based on timing and duration.
Someone with more rapid mood switches is generally diagnosed with a mixed episode, characteristic of mood instability in borderline personality disorder (BPD).1
See below for a breakdown of cycle frequency:4
- Classical rapid cycling: 3 days to 12 weeks (4 episodes per year)
- Ultra rapid: 3 days ( 4 episodes per month)
- Ultra-ultra rapid or ultradian: 24 hours
Rapid cycling can also be distinguished by precipitating factors. Spontaneous rapid cycling generally has an earlier age of onset and is not as responsive to lithium treatment, whereas induced rapid cycling tends to start later and is more responsive to treatment.
What Are the Symptoms of Rapid-Cycle Bipolar Disorder?
The symptoms of rapid-cycling bipolar disorder are the same as those exhibited in traditional bipolar disorder. As such, someone with rapid-cycle bipolar disorder will experience both manic and depressive episodes.
Manic Episode
Symptoms of a manic episode include the following:
- Feelings of being “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, like they can do anything
In the midst of a manic episode, people may exhibit highly unusual behavior that is unrecognizable to family and peers. They won’t be able to recognize the shift either, insisting that they feel great or are being the best version of themselves.1
Depressive Episode
Symptoms of a depressive episode include 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 forgetfulness
- Inability to carry out even simple tasks
- Little interest in activities and anhedonia (i.e., the inability to experience pleasure)
- Increased thoughts of death or suicide
Someone 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
How Is Bipolar Disorder With Rapid-Cycling Diagnosed?
Although the symptoms of rapid-cycle bipolar disorder are the same as traditional bipolar disorder, timing distinguishes the two. Rapid cycling is not a diagnosis itself, rather, it is a course specifier or descriptor of bipolar disorder. To be diagnosed, you must experience episodes lasting between 3 days and 12 weeks, with four or more of these episodes within one year.
This pattern can be difficult to identify because a single mood episode can wax and wane without fully resolving. In this case, they do not represent multiple and distinct episodes. Many people with rapid-cycling bipolar disorder are misdiagnosed with unipolar depression because they tend to spend more time depressed vs. manic or hypomanic.2
5 Potential Causes of Rapid-Cycling Bipolar Disorder
Experts are unsure what exactly causes traditional or rapid-cycling bipolar disorder. However, many of the potential causes or triggers of rapid-cycling are similar to those of traditional bipolar disorder.
Here are five potential causes or triggers of rapid-cycle bipolar disorder:
- Drugs
- Substance misuse
- Pregnancy
- Traumatic event
- Various somatic and mental health disorders
Who Is Most Likely to Develop Rapid-Cycling Bipolar Disorder?
Although it is difficult to identify who is most at risk, there are several common risk factors associated with rapid-cycling bipolar disorder, including the following:
- Sex: women seem to be at a higher risk for developing rapid-cycling bipolar disorder. This may be attributed to hormonal changes during menstrual cycles or postpartum.
- Age: people who develop bipolar disorder at a younger age (adolescence) are more likely to develop rapid cycles.
- Type of bipolar: those people diagnosed with bipolar 2 may be more likely to experience rapid cycles.
- Depressive episode at onset: those who experience a depressive episode at the onset of their bipolar disorder are more likely to develop rapid cycles.
What Are the Risks of Rapid-Cycling Bipolar Disorder?
Those suffering from rapid-cycling bipolar disorder are at a greater risk of alcohol and substance misuse. Many people with this condition self-medicate to cope with or alleviate their symptoms. They’re also at an increased risk for suicide and self-harm. Generally, because mood swings occur at such a high volume, rapid cyclers find it difficult to commit to a set schedule, which makes it almost impossible to get or keep a job.3
How Is Bipolar Disorder With Rapid Cycling Treated?
Rapid-cycling bipolar disorder is more difficult to treat than traditional bipolar disorder; however, certain medications may prove effective. Mood stabilizers, when combined with an antipsychotic, can help people manage symptoms of mania and hypomania. Lithium is the primary form of mood-stabilizing treatment, as well as Depakote, Lamictal, or Tegretol.
Antidepressants, on the other hand, have been shown to be ineffective, and may actually lead to an increased speed of cycling. Taking antidepressants can be dangerous in a person with bipolar disorder and lead to mood destabilization.5
While it is always preferable to combine medication with a form of talk therapy like cognitive behavioral therapy (CBT), medication is the primary form of treatment to properly manage the symptoms of rapid-cycling and traditional bipolar disorder.4 To find a therapist who specializes in the treatment of bipolar, consider using a directory like Choosing Therapy.
Final Thoughts On Bipolar Disorder With Rapid Cycling
Everyone’s experience with traditional bipolar or rapid-cycling bipolar disorder is personal, which can feel isolating. But remember, you’re not alone. Connecting with a skilled therapist or mental health professional can help, becoming the foundation of a strong support system. With support and the right medication, you can lead a healthy and fulfilling life.
