Rapid cycling bipolar disorder is characterized by
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
- Overview
- Symptoms & Types
- Treatment & Prevention
- Living & Support
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.
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.
The cause of rapid cycling is unknown however, there are several theories that have been posed:
KindlingThe 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 RhythmsThis 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.
Anti-DepressantsIt 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.
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 TrackingKeeping 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 TherapyTalk 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.
What are BAR fast cycles?
05/08/2017 Masha Pushkina, psychoeducator Types and types of BAD, Favorites 0
Rapid cycles are not uncommon. They occur in about one in four patients with bipolar disorder.
Rapid cycling for bipolar disorder (from the English - `rapid cycling`) means frequent mood swings, when during the year a person experiences at least four (or more) manic, hypomanic or depressive episodes.
Why do fast cycles occur and why is it dangerous?
In a person with bipolar disorder with fast cycling, the mood rises and falls, up and down, and back, and such fluctuations can occur over several days and even hours. The person feels like on a roller coaster, with powerful shifts in mood and activity that are out of control. For some, rapid cycling is manifested by intense irritability, anger, impulsiveness, and sudden outbursts of aggression.
In rapid cycling bipolar disorder, episodes follow each other in a random order.
Some patients may experience true mania, hypomania or depression in just one day. The fast-cyclic course of BAD has several subspecies.
If there are 4 mood swings in a month, this is called "ultra-fast cycling", if several alternations of episodes occur in one day or for several days within one week, this is "ultra-ultra-fast cycling", or "ultra-range cycling".
Generally, those with bipolar disorder have a low range of mood swings and experience longer episodes. In some "bipolar" BC (rapid cycles) are observed from the beginning of the course of the disease, but in many the disease takes on this form over time.
Most people with bipolar disorder, in fact, begin to experience shorter and more frequent episodes over the course of the illness if not properly treated. For some people, the appearance of fast cycles is a temporary phenomenon.
It is possible to experience rapid episodes for a while and then return to longer periods and less frequent swings, and at best to a stabilized mood with treatment.
Only a few people have bipolar disorder with a fast-cycling form for a long time.
It is important to see a doctor right away to find the most appropriate and effective treatment for this form of bipolar disorder, because the longer a person goes without treatment, the more drug-resistant the disease becomes.
Who develops rapid cycling bipolar disorder?
Nearly half of people with bipolar disorder will experience rapid cycles at some point. There is no definite answer as to who is more likely to have them, but women are more prone to rapid cycles than men, although the disease is equally common among both sexes. An increase in the frequency of episodes can be triggered by taking certain antidepressants.
Fast cycles often disappear when they are stopped, but be aware of the possibility of recurrence of depressive episodes, so work with your doctor to find a more effective combination of drugs, and never stop medication or change dosage without first discussing with a specialist .
Undoubtedly, there is an indisputable relationship between the appearance of fast cycles and the use of drugs or alcohol. Substance abuse makes a person more prone to rapidly cycling bipolar disorder. According to the results of the research, it was revealed that alcohol and drug addiction is more common in families of patients with BAD with a fast-cycle form than in families of patients with BAD without fast cycles. Whether this is the result of a genetic link between substance abuse or a consequence of self-medication is unknown.
Causes of rapid cycling bipolar disorder
The underlying cause of rapid cycling remains unknown, but there are three theories.
Sensitization
Sensitization is an increase in the sensitivity of nerve centers under the influence of an irritant. The theory is that early episodes occur due to various triggers. These can be different events: from the death of a loved one to the upcoming interview.
Over time, a person with bipolar disorder becomes increasingly sensitive to small triggers or stressors and is more likely to experience episodes in response to stressful situations. In the end, the person begins rapid cycles without any "triggers". The episodes become more frequent and the end result, if the disease is not properly treated, may be rapid, ultra-rapid or ultra-range cycling.
Biorhythm disorders
This theory states that in patients with CD, daily biorhythms are not synchronized with such phenomena as dawn and dusk. The disruption of jet lag leads to the sleep disturbances characteristic of mania and depression, as well as other symptoms. There may also be an association between BC and seasonal affective disorder. Abnormal circadian biological rhythms do not cause illness but contribute to the duration and severity of a manic or depressive episode. Therefore, it is better to treat insomnia in a timely manner.
Hypothyroidism
The rapid alternation of episodes of mania, hypomania and depression may be caused by a lack of thyroid hormone in the brain.
Most fast cycling people have normal thyroid levels but may respond well to thyroid hormone treatment regardless of the thyroid level.
Are there effective treatments for the rapid cycling course of bipolar disorder?
Yes, although it is difficult to find the right treatment. People with bipolar disorder should not despair if the first few medications or drug combinations prescribed are not successful. There are many different treatment options.
Watch what works for you and what doesn't work or doesn't work to help your doctor decide on future medications. Be sure to discuss adding any medications to your treatment, including natural herbal supplements, with your doctor.
Psychotherapy should be an important part of your treatment plan. In addition to being at risk for another manic or depressive episode, people with bipolar disorder may also have difficulty coping with the effects of past episodes. Feelings such as irritability, tearfulness, racing thoughts or impulsiveness lead to social problems.
Because people with bipolar disorder are often unfairly judged, they may lose the opportunity to develop friendships or romantic involvement, or have difficulty achieving their career goals. These factors contribute to self-esteem issues. That is why people with bipolar disorder should work with psychotherapists, in person with a doctor, or with family members. It is important to have a treatment plan that works and stick to it, and to work on preventing suicidal thoughts as it is vital.
Diagnosing your condition can help you and your doctor identify what's causing your stress, track which medications are working for you, and prevent new episodes. You can try keeping a personal mood calendar, writing down the medications you take, keeping track of mood changes, and noting stressful situations, side effects, and other symptoms.
Conclusion
Research shows that the rapid cycling course of bipolar disorder differs from other forms of it. Patients with fast cycling may respond differently to standard and experimental treatments than people with standard bipolar disorder.
With sudden and unpredictable mood changes, episodes are more difficult to bear. It is highly recommended to interact with your doctor, stick to a suitable treatment plan and not give up hope.
Nadia Abramova
: a guide to survival.
Not Found (#404)
hide menu
Issues of the current year
-
1
-
1-2 (138)
1
Issue 1 content, 2023
-
Anxiety at the hour of war: encouragement of summer people for crisis conditions
-
Possibility of correction of dysfunction of the brain of degenerative and vascular character
-
Geriatric syndromes in clinical practice
L.
