Cyclothymia rapid cycling

Rapid Cycling Bipolar Disorder Symptoms, Treatments, Causes, and More

Written by Matthew Hoffman, MD

In this Article

  • What Is Rapid in Cycling Bipolar Disorder?
  • Who Gets Rapid Cycling Bipolar Disorder?
  • What Are the Features of Bipolar Disorder?
  • How Is Rapid Cycling Bipolar Disorder Identified?
  • How Is Bipolar Disorder with Rapid Cycling Treated?
  • What Are the Risks of Rapid Cycling Bipolar Disorder?

What Is Rapid in Cycling Bipolar Disorder?

Rapid cycling is a pattern of frequent, distinct episodes in bipolar disorder. In rapid cycling, a person with the disorder experiences four or more episodes of mania or depression in one year. It can occur at any point in the course of bipolar disorder, and can come and go over many years depending on how well the illness is treated; it is not necessarily a "permanent" or indefinite pattern of episodes.

Who Gets Rapid Cycling Bipolar Disorder?

Virtually anyone can develop bipolar disorder. About 2.5% of the U.S. population suffers from some form of bipolar disorder - nearly 6 million people. A rapid cycling pattern may occur in about 10% to 20% of people with the disorder. Women, and people with bipolar II disorder, are more likely to experience periods of rapid cycling.

Most people are in their late teens or early 20s when symptoms of bipolar disorder first start. Nearly everyone with bipolar disorder develops it before age 50. People with an immediate family member with bipolar disorder are at higher risk.

What Are the Features of Bipolar Disorder?

The major features of bipolar disorder include:

  • At least 1 episode of mania or hypomania in the patient's lifetime
  • Episodes of depression (major depressive disorder), which are often recurrent

Mania is a period of abnormally elevated mood and high energy, usually accompanied by erratic behavior lasting at least seven days at a time. Hypomania is an elevated mood not reaching full-blown mania and lasting a minimum of four days.

A few people with rapid cycling bipolar disorder alternate between periods of hypomania and major depressive disorder. Far more commonly, though, repeated and distinct episodes of depression dominate the picture. Repeated periods of depression are punctuated by infrequent, shorter periods of elevated or normal mood.

How Is Rapid Cycling Bipolar Disorder Identified?

Bipolar disorder is diagnosed after someone experiences a hypomanic or manic episode along with multiple additional episodes of either mania, hypomania or depression. Rapid cycling in itself is not a diagnosis, but rather a "course specifier" or descriptor of the course of illness. In bipolar disorder rapid cycling is identified when four or more distinct episodes of depression, mania, or hypomania occur during a one year period. 

Rapid cycling bipolar disorder can be difficult to identify, because a single mood episode can sometimes simply wax and wane without resolving. As a result, they don't necessarily represent multiple separate and distinct episodes. Rapid cycling may seem to make the changing mood states of bipolar disorder more obvious, but because most people with rapid cycling bipolar disorder spend far more time depressed than manic or hypomanic, they are often misdiagnosed with unipolar depression.

For example, in one study of people with bipolar II disorder, the amount of time spent depressed was more than 35 times the amount of time spent hypomanic. Also, people often don't take note of their own hypomanic symptoms, mistaking them for a period of unusually good mood.

How Is Bipolar Disorder with Rapid Cycling Treated?

Because symptoms of depression dominate in most people with a rapid cycling course of bipolar disorder, treatment is usually aimed toward stabilizing mood, mainly by relieving depression while preventing the comings-and-goings of new episodes.

Antidepressants such as fluoxetine (Prozac), paroxetine (Paxil,) and sertraline (Zoloft) have not been shown to treat the depression symptoms of rapid cycling bipolar disorder, and may even increase the frequency of new episodes over time. Many experts therefore advise against the use of antidepressants (especially long term) in bipolar patients with rapid cycling.

Mood-stabilizing drugs -- such as carbamazepine (Tegretol), lamotrigine (Lamictal ), lithium (Lithobid), and valproate (Depakote)-- are the core treatments of rapid cycling. Often, a single mood stabilizer is ineffective at controlling episode recurrences, resulting in a need for combinations of mood stabilizers. Several antipsychotic medicines such as olanzapine (Zyprexa) or quetiapine (Seroquel) also have been studied in rapid cycling and are used as part of a treatment regimen, regardless of the presence or absence of psychosis (delusions and hallucinations).

Treatment with mood stabilizers is usually continued (often indefinitely) even when a person is symptom-free. This helps prevent future episodes. Antidepressants, if and when used, are generally tapered as soon as depression is under control.

What Are the Risks of Rapid Cycling Bipolar Disorder?

The most serious risk of a rapid cycling course in bipolar disorder is suicide. People with bipolar disorder are 10 times to 20 times more likely to commit suicide than people without bipolar disorder. Tragically, 8% to 20% of people with bipolar disorder eventually lose their lives to suicide.

People with a rapid cycling course may be at even higher risk for suicide than those with nonrapid cycling bipolar disorder. They are hospitalized more often, and their symptoms are usually more difficult to control long term.

Treatment reduces the likelihood of serious depression and suicide. Lithium in particular, taken long term, has been shown to reduce the risk.

People with bipolar disorder are also at higher risk for substance abuse. Nearly 60% of people with bipolar disorder abuse drugs or alcohol. Substance abuse is associated with more severe or poorly controlled bipolar disorder.

Bipolar Disorder Guide

  1. Overview
  2. Symptoms & Types
  3. Treatment & Prevention
  4. Living & Support

Cyclothymia (cyclothymic disorder) - Symptoms and causes


Cyclothymia (sy-kloe-THIE-me-uh), also called cyclothymic disorder, is a rare mood disorder. Cyclothymia causes emotional ups and downs, but they're not as extreme as those in bipolar I or II disorder.

With cyclothymia, you experience periods when your mood noticeably shifts up and down from your baseline. You may feel on top of the world for a time, followed by a low period when you feel somewhat down. Between these cyclothymic highs and lows, you may feel stable and fine.

Although the highs and lows of cyclothymia are less extreme than those of bipolar disorder, it's critical to seek help managing these symptoms because they can interfere with your ability to function and increase your risk of bipolar I or II disorder.

Treatment options for cyclothymia include talk therapy (psychotherapy), medications and close, ongoing follow-up with your doctor.

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Cyclothymia symptoms alternate between emotional highs and lows. The highs of cyclothymia include symptoms of an elevated mood (hypomanic symptoms). The lows consist of mild or moderate depressive symptoms.

Cyclothymia symptoms are similar to those of bipolar I or II disorder, but they're less severe. When you have cyclothymia, you can typically function in your daily life, though not always well. The unpredictable nature of your mood shifts may significantly disrupt your life because you never know how you're going to feel.

Hypomanic symptoms

Signs and symptoms of the highs of cyclothymia may include:

  • An exaggerated feeling of happiness or well-being (euphoria)
  • Extreme optimism
  • Inflated self-esteem
  • Talking more than usual
  • Poor judgment that can result in risky behavior or unwise choices
  • Racing thoughts
  • Irritable or agitated behavior
  • Excessive physical activity
  • Increased drive to perform or achieve goals (sexual, work related or social)
  • Decreased need for sleep
  • Tendency to be easily distracted
  • Inability to concentrate

Depressive symptoms

Signs and symptoms of the lows of cyclothymia may include:

  • Feeling sad, hopeless or empty
  • Tearfulness
  • Irritability, especially in children and teenagers
  • Loss of interest in activities once considered enjoyable
  • Changes in weight
  • Feelings of worthlessness or guilt
  • Sleep problems
  • Restlessness
  • Fatigue or feeling slowed down
  • Problems concentrating
  • Thinking of death or suicide

When to see a doctor

If you have any symptoms of cyclothymia, seek medical help as soon as possible. Cyclothymia generally doesn't get better on its own. If you're reluctant to seek treatment, work up the courage to confide in someone who can help you take that first step.

If a loved one has symptoms of cyclothymia, talk openly and honestly with that person about your concerns. You can't force someone to seek professional help, but you can offer support and help find a qualified doctor or mental health provider.

Suicidal thoughts

Although suicidal thoughts might occur with cyclothymia, they're more likely to occur if you have bipolar I or II disorder. If you're considering suicide right now:

  • Call 911 or your local emergency services number, or go to a hospital emergency department.
  • Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

If you just can't make that call, reach out to someone else — immediately — such as your doctor, mental health provider, family member, friend or someone in your faith community.

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It's not known specifically what causes cyclothymia. As with many mental health disorders, research shows that it may result from a combination of:

  • Genetics, as cyclothymia tends to run in families
  • Differences in the way the brain works, such as changes in the brain's neurobiology
  • Environmental issues, such as traumatic experiences or prolonged periods of stress

Risk factors

Cyclothymia is thought to be relatively rare. But true estimates are hard to make because people may be undiagnosed or misdiagnosed as having other mood disorders, such as depression.

Cyclothymia typically starts during the teenage years or young adulthood. It affects about the same number of males and females.


If you have cyclothymia:

  • Not treating it can result in significant emotional problems that affect every area of your life
  • There is a high risk of later developing bipolar I or II disorder
  • Substance misuse is common
  • You may also have an anxiety disorder
  • You may be at increased risk of suicidal thoughts and suicide


There's no sure way to prevent cyclothymia. However, treatment at the earliest indication of a mental health disorder can help prevent cyclothymia from worsening. Long-term preventive treatment also can help prevent minor symptoms from becoming full-blown episodes of hypomania, mania or major depression.

By Mayo Clinic Staff


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Types of Bipolar Disorder - Psychotherapist's Consultation

Types of Bipolar Disorder - Depending on how you experience different bipolar moods and symptoms and how severely they affect you, your doctor may diagnose you with a specific type of bipolar disorder. These are some of the terms your doctor may use.

Types of bipolar disorder:

Bipolar I disorder

You may be told that you have bipolar I disorder if you have had at least one episode of mania that lasted longer than a week. nine0003

You may also have had episodes of depression, although not everyone has.

Bipolar II

You may be diagnosed with bipolar II if you have experienced at least one episode of major depression and symptoms of hypomania.


Cyclothymia can be diagnosed if you have experienced both hypomanic and depressive mood states. for two or more years and your symptoms are not severe enough to meet the criteria for a diagnosis of bipolar I disorder or bipolar II disorder. nine0003

This can be a difficult diagnosis because you may feel like you are being told that your symptoms are not “severe enough” but they are not. Mental health is a spectrum that includes many different experiences, and cyclothymia can seriously affect your life.

Using these terms can help both you and your health care providers to be more specific about your diagnosis and treatment. If your doctor ever uses words or phrases that you do not understand, you can ask for an explanation. nine0003

“I have cyclothymia. It can make you feel like it's all in your head, as the symptoms are often not as severe as bipolar disorder."

How common are bipolar attacks?

This may depend on many factors, such as:

your exact diagnosis

how well you can manage your symptoms, whether certain situations or events may trigger your episodes (for example, you may find that not getting enough sleep during a stressful life event may trigger an episode of mania)

how you personally define the series

What is normal for you can also change over time. However, many people find that:

mania can start suddenly and last from two weeks to four or five months

depressive episodes can last longer - sometimes several months.

Cycling fast

You may be told that your bipolar disorder is fast cycling if you have experienced four or more depressive, manic, hypomanic, or mixed episodes in a year. This may mean that you feel stable for several weeks between episodes, or that your mood can change as quickly as during the same day or even at the same hour. nine0003

Fast cycling is currently not officially accepted. is considered a separate type of bipolar disorder, but more research is needed to know for sure or better understand it.

There are also often stable or neutral periods between episodes. This does not mean that you are not emotional at this time - just that you are not currently experiencing mania, hypomania, or depression, or that you are coping effectively with your symptoms. You may feel stable for years between episodes, although for some people the periods of stability may be much shorter. nine0003

“It's a lot harder to come to terms with stability than I could imagine. I had to struggle with a 'new' identity and lifestyle after spending so many years reflecting on the ups and downs of bipolar disorder."

We hope this article will give you more information on the types of bipolar disorder.

#types of bipolar disorder

What is a fast bike for bipolar disorder? | mental health articles | Emotional & Mental Health center

Cycling fast is a phenomenon that not all people diagnosed with bipolar disorder experience, but most people will. Read on to learn about the most common triggers and how to best manage this type of disorder.

Having four or more hypomanic, manic, or depressive episodes per year means you are more likely to be diagnosed with bipolar disorder with fast cycling. Episodes can occur in any combination and order, but there must be at least four. nine0003

Fast cycling occurs in 10-20 percent of people with bipolar disorder, mostly women, and develops later in the course of the disease. It is important to note that fast cycling is not strictly associated with a specific type of bipolar disorder. This can happen to any type, but fortunately it's just a temporary inconvenience for some patients - most of them will experience it at some point, but there are also periods when the label won't apply. nine0003

Rapid cycling is not a specific disease, but a course of bipolar disorder, the symptoms of which are identical to those of any of the four main types of bipolar disorder:

  • Bipolar disorder I
  • Bipolar disorder II
  • Cyclothymic disorder
  • Other specified and unspecified bipolar and related disorders

What differs from cycling fast compared to the "normal" course of the disease is the rate at which episodes of hypomania, mania, or depression alternate. It comes with unpredictable mood swings - there's no way to know when an episode is about to hit. For some people, this happens every few months, even a few days, and there are even people who go through these phases a couple of times every day. nine0003

Possible triggers for fast cycling in bipolar disorder

Scientists still don't know exactly why some people develop fast cycling, but besides being a woman with bipolar disorder and specific hormonal fluctuations, some others factors may contribute to the development of fast cycling.

Age of onset

Some researchers have found that the age at which you first develop symptoms of bipolar disorder plays a big role in determining the type of illness and intensity of symptoms, so it is clear that an earlier age of onset means that a person is more likely to become fast cycler with bipolar disorder II. nine0003


Going through certain stressors without treatment for bipolar disorder can be one possible reason for cycling fast. This theory is known as the sensitization or "kindling hypothesis" and it lies on

Research shows that people are becoming more and more sensitive to external stimuli. People tend to experience minor negative life events prior to the depressive phase and minor positive life events prior to hypomania. These stressors were not severe enough to cause the first onset of bipolar disorder, but now frequently cause recurrent bipolar episodes. nine0003


According to several recent studies, the use of antidepressants meant more depressive episodes in those who continued antidepressant treatment than in those who stopped treatment. Well-known antidepressants such as Prozac or Zoloft have proven ineffective in treating fast cycles, and they may even increase the frequency of episodes. That's why many psychotherapists are now prescribing antidepressants along with mood stabilizers like lithium, making them much less likely to ride fast. nine0003

Other health conditions

Fast cycling has been associated with a number of other health conditions such as neurological disease, multiple sclerosis, low thyroid function, developmental delay, and some head injuries.

What is it like to live with fast cycling?

There are several types of bipolar disorder. Someone can be depressed most of the time with a few brief hypomanic episodes. Someone else can be manic most of the time, meaning overly excited, impulsive, and grandiose. nine0003

People call fast cycling a giant roller coaster without knowing how long the ride is. It can be exciting when you climb up, but the knowledge that you will soon fall again and again leads to anxiety and depression. It can be exhausting to find your neutral state when you have bipolar disorder with fast cycling - people describe it as a constant war with yourself.

It can be difficult to keep track of all changes in a person's mood since

Most people with bipolar disorder cannot maintain their old schedule when they are first diagnosed until a new regimen with medication and talk therapy is fully established. Most aspects of life tend to suffer, including personal relationships, careers, and everything else in between. This is the time when they need support the most; knowing they can count on someone is priceless.

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