Fast cycle bipolar

Rapid Cycling Bipolar Disorder - DBSA

Bipolar disorder with rapid cycling is diagnosed when a person experiences four or more episodes of mania, hypomania, or depressive episodes in any 12-month period. Rapid cycling can occur with any type of bipolar disorder, and maybe a temporary condition for some people.

What is rapid cycling? 

People who live with bipolar experience the “highs” that come with mania or hypomania, they also experience “lows” that come with depression. When Rapid Cycling occurs, it means that four or more manic, hypomanic, or depressive episodes have taken place within a twelve-month period. Changes in mood here can happen quickly and occur over a few days or even over a few hours. If there are four mood changes within a month, it is called ultra-rapid cycling. While the phrase “rapid cycling” may make it seem that there is a regular cycle to these shifts in mood, most cycles do not follow a pattern.

Who develops rapid cycling?

As many as half of all individuals who live with bipolar may develop rapid cycling at some time. For most, rapid cycling is a temporary occurrence. For a small number of individuals, the pattern of cycling can continue indefinitely. While there are no hard rules for who will develop rapid cycling, it may be more likely to develop in women. Bipolar is equally common in both genders.

What causes rapid cycling?

The cause of rapid cycling is unknown however, there are several theories that have been posed:


The kindling theory proposes that early episodes are triggered by actual or anticipated life events. Stressful circumstances such as loss of a job or of a loved one may become ‘triggers’ for that individual. Again, this can be actual or anticipated. Perceived or actual stress associated with these circumstances may result in the cycling of mood seen in rapid cycling. As the triggers continue to present themselves an individual can experience the increase of cycling.

Circadian or Biological Rhythms

This theory proposes that individuals who experience rapid cycling are “out of sync” with their typical biological rhythms. Circadian rhythms represent the 24-hour cycle that people experience each day. This rhythm keeps people in sync with dusk and dawn, sleep, and activity. While it is uncertain if inconsistency with circadian rhythms can cause rapid cycling, it is understood that good sleep hygiene can mitigate symptoms associated with bipolar.


Hypothyroidism means that the thyroid is underactive in the system and is not producing enough of the thyroid hormone for the brain. Some with rapid cycling have responded to treatment with the thyroid hormone.


It has been found that anti-depressants can increase the frequency of cycling. Some experts have advised against the use of anti-depressants in individuals living with bipolar, especially for the long term. More commonly individuals living with bipolar are prescribed mood-stabilizing drugs which can be a treatment for rapid cycling. Before changing medication, talk to your physician. Do not stop medication without first consulting with your physician.

Treatment for Rapid Cycling

Rapid cycling is not its own diagnosis, rather a specifier that defines how the course of a bipolar diagnosis is experienced. It can be difficult to treat rapid cycling, however, people may find benefit in talk therapy and tracking their mood.

Mood Tracking

Keeping track of your mood may help you understand patterns that cause stress. By keeping records of mood changes, as well as lifestyle factors such as sleep, diet, exercise you can better understand what may trigger mood shifts.

Talk Therapy

Talk therapy can help people to identify and stick to a specific treatment plan. Collaborating with a therapist can help people who are experiencing rapid cycling. Feelings such as irritability, sadness, and racing thoughts can interfere with day to day life. By talking to a therapist those feelings can be explored in a “judgment free zone. ” Establishing a treatment plan with a therapist can help you keep track of what improves or worsens symptoms.






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

Rapid cycling bipolar affective disorder and association with lunar phases

The belief that the full moon can somehow influence human behavior is deeply rooted in culture, language and clinical knowledge and is generally considered a myth in the scientific community because it is not supported by epidemiological studies. The inability to detect such an effect in the modern era, when light pollution almost completely canceled out the change in the brightness of the night sky in the lunar phase, does not mean that this effect was absent in previous centuries, when the nights were darker. So, in natural habitats, other species of primates usually become more active at night under a full moon. There are also numerous examples of lunar cycles in other animal species. nine0003

The author of the new study, Wehr T. A., took an approach that differs from that of epidemiological studies, looking for evidence of lunar phases in extensive longitudinal case reports in patients with rapidly cycling bipolar affective disorder (BAD). This type of bipolar disorder is characterized by a noticeable and easily identifiable “switching process” in which people abruptly switch from depression to mania and vice versa within one day (here we are talking about ultra-fast cycles - 4 or more affective phases within a month, because in rapid-cycling bipolar disorder, there are more than four episodes of mania, depression, or a mixed state during the year - approx. PiN). nine0003

The author studied data on 17 patients whose mood cycles showed a 35.5-day periodicity, the accuracy and stability of which, for several years, suggested that they could arise from a non-biological, but external, clock-like source. The fact that 35.5 days represents the average duration of several tidal cycles and that the recurring pattern in the mood cycle coincided with the 206-day supermoon cycle suggests that the moon may be the external source. nine0003

To investigate the hypothesis of an association between mood swings and two-week tidal cycles and supermoon cycles, the author conducted a retrospective study of 16 additional fast cycle bipolar patients. It is worth noting that these types of lunar cycles are reflected in the behavior of many other animals, and that lunar gravimetric cycles are not affected by light pollution that has obscured the moon's brightness.

During the study, it was found that fast bipolar mood cycles showed synchrony with various lunar cycles. For example, the onset of manic episodes in patients was synchronous with every second (n=8), third (n=11), fourth (n=2) or sixth (n=1) biweekly lunar tidal cycle (Figure 1). nine0003

Considering the fact that the force that all lunar cycles obey is gravity, then if we assume that the associations between lunar cycles and mood cycles are causal in nature, then we can draw the following conclusions: 1 - lunar gravimetric cycles affect the course of bipolar disease, 2 - people have a biological system that can respond to lunar gravimetric cycles directly or indirectly through an intermediate variable, 3 - the work of this biological system is part of the mechanism for the development of bipolar disorder. nine0003

Future research is needed to determine whether these results can be replicated and whether they can be extended more widely to other biological phenomena.

Comment: Despite the controversial design and results of this study, it was in the Top 10 most viewed articles on the Molecular Psychiatry site for the month. Perhaps it's just a non-standard approach, but given the growing popularity of the chronobiological theory of affective disorders, this study, or rather the hypothesis that is given in the conclusions, has a place for further critical reflection. nine0038

Prepared by: Kasyanov E.D.

Source: T. A. Wehr. Bipolar mood cycles and lunar tidal cycles. Molecular Psychiatry advance online publication 24 January 2017; doi: 10.1038/mp.2016.263

Cyclothymia: how it differs from bipolar disorder and how to treat it

March 23, 2021 Likbez Health

If periods of excitement are replaced by depression, this is a reason to be wary. nine0003

What is cyclothymia

Cyclothymia (from the Greek words “cycle” and “thymia” - soul) is a mental disorder in which at least once every few weeks a person has a sudden change in mood. He experiences either extreme apathy, melancholy, sadness, then euphoria, cheerfulness, a desire to move mountains. And there is practically no balanced middle, an island of calm, when everything around would not be painted in unambiguously black or exceptionally light colors, there is practically no such violation in the life of a person. nine0003

Where cyclothymia comes from

The cause of the disorder is not known. The researchers suggest that cyclothymia may be genetic and inherited, just as it happens with a tendency to develop depression or bipolar disorder.

In some cases, cyclothymia is triggered by stressful situations, such as unrequited love, illness, or the death of a loved one. Chronic stress can also play a role. nine0003

Most often, cyclothymia begins in adolescence. At first, they do not notice it, confusing it with the usual teenage imbalance. However, over the years, the symptoms can become more severe and destructive.

How is cyclothymia different from bipolar disorder

There is indeed a lot in common between the two. So much so that cyclothymic disorder is considered to be a mild form of bipolar disorder. And this apparent ease of the condition is a problem, because it makes diagnosis very difficult. nine0003

How bipolar disorder manifests itself

Bipolar, or manic-depressive psychosis, has severe symptoms. That is, tangible mood swings from a conditional minimum (depression) to a maximum (mania).

Typically, bipolar disorder is a combination of four conditions: episodes of moderate and severe depression, and mania and hypomania.

These episodes can last for weeks or months. And when it comes to depression, even for years. But nevertheless, the transition from one mood to another is so abrupt that it is impossible to miss. nine0003

Mania and hypomania

Mania and hypomania show the same symptoms. It's just that the first one is more pronounced and harder: it causes more noticeable problems at work, in school, in relationships.

To diagnose a manic or hypomanic episode, at least three signs are sufficient:

  • an exaggerated sense of well-being, happiness;
  • increased energy;
  • excited state - a person seems quick-tempered, irritable, easily and very actively ignites new ideas; nine0094
  • overly optimistic view of the world;
  • decreased need for sleep;
  • unusual talkativeness;
  • quick, confused thoughts;
  • trouble concentrating;
  • inability to appreciate the consequences of one's actions, propensity for risky behavior - excessive spending, casual sex, episodes of dangerous driving.
Severe and moderate depression

Depressive episodes also have the same symptoms. A major depressive episode, characteristic of bipolar disorder, is diagnosed if these symptoms are very pronounced and there are at least five of them:

  • Constantly depressed mood. Sadness, a feeling of emptiness and hopelessness.
  • Marked loss of motivation and interest in anything, including favorite activities and hobbies. And if a person still continues his usual activity, it does not bring him pleasure and is performed automatically.
  • Weight fluctuations. They occur due to the fact that in a depressed state, a person begins to eat less or more than usual.
  • Sleep disorders such as insomnia or excessive sleepiness during the day. nine0094
  • Anxiety, anxiety or, on the contrary, complete apathy.
  • Constant fatigue.
  • Feelings of worthlessness or guilt.
  • Inability to plan and make decisions.
  • Suicidal thoughts.

How cyclothymia manifests itself

Unlike bipolar disorder, cyclothymia is a blurred condition. Emotional ups and downs in this disorder are not so serious: only hypomania and mild depression are present. So people who suffer from mood swings often assume that they are fine and do not seek help. nine0003

Due to the mildness, smoothness of manic and depressive episodes, cyclothymia often goes undiagnosed and untreated. Although it should.

Why is cyclothymia dangerous? A person becomes easily excitable, nervous, cannot predict how he will behave in a given situation.

Such unpredictability seriously affects personal and work relationships, does not allow starting a family, interferes with a career, pushes to rash actions. nine0003

All this makes cyclothymia not a relatively harmless emotionality, but a full-fledged mental disorder, which is included in the International Classification of Diseases (ICD-10).

But the decline in the quality of life is not the only problem. Over time, cyclothymia often develops into anxiety or bipolar disorder.

How cyclothymia is diagnosed

Mood swings happen to everyone, and they do not always indicate a mental disorder. According to the American Psychiatric Association's diagnostic criteria, certain conditions must be met to make a diagnosis of cyclothymia. Here is how experts from the American Mayo Clinic describe them. nine0003

  • A person regularly has periods of depression, when everything is bad, everything falls out of hand, he is not interested in anything, he does not want anything, followed by periods of energy, excitement, a feeling of happiness. Then the attack of melancholy and apathy is repeated. And so in a circle.
  • These mood swings have been going on for at least two years.
  • During a two-year period, at least half of the time a person spends either in apathy or in a state similar to euphoria. nine0094
  • A person either cannot remember periods without excitement or melancholy, or they last for a short time - no longer than a couple of months.
  • Symptoms are not related to substance use or any diagnosed medical condition.

What to do if you suspect cyclothymia

Unfortunately, this disorder does not go away on its own. Therefore, it is important to seek help before cyclothymia develops into bipolar disorder.

You should talk about your condition with a therapist or, better, with a psychotherapist. The doctor will help to understand whether the symptoms are a sign of a mental disorder or whether it is still a natural emotionality associated with fatigue and other life circumstances. nine0003

If you think a loved one has symptoms of cyclothymia, try to have a sincere conversation with them. You cannot force someone to seek professional help, but you can offer support and help find a qualified doctor.

How cyclothymia is treated

The point of treatment is:

  1. Stop cyclothymia from developing into bipolar disorder.
  2. Reduce mood swings. nine0094
  3. Prevent the patient from relapsing into depression or unproductive euphoria.

As a rule, in order to achieve these goals, doctors suggest acting like this.

Undergo psychotherapy

Cognitive-behavioral therapy has proved to be the best. It makes it possible to understand exactly what events, experiences cause sharp mood swings. Knowing this, a person will be able to avoid triggers, and if it is not possible to completely avoid them, then it is better to control yourself. A psychotherapist will also teach you how to deal with stress. nine0003

Establish and maintain a daily routine

For people with mood disorders, it can act as an anchor to help them stay calm and balanced.

The schedule will clearly define what time to wake up, when to have breakfast, lunch and dinner, what time to take for walks and exercise, when to go to bed. It is important to strictly follow the routine until it becomes a healthy habit.

Take prescribed medicines

There is no magic pill for cyclothymia. But the doctor can prescribe drugs that will make the mood more stable.

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