Rapid cycling bipolar ii
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 is a fast bike in bipolar disorder? | mental health articles | Emotional & Mental Health center
Fast cycling is a phenomenon that not all people diagnosed with bipolar disorder experience, but most 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.
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.
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.
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.
Stress
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.
Antidepressants
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.
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.
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.
Fast cycling can sometimes precede the more devastating manifestations of bipolar illness such as psychosis. Also, people with fast cycling are now known to respond poorly to treatment, especially lithium, but possibly other medications as well, so it's important to visit your GP frequently to discuss your condition and your options.
Finding the right treatment can be a lengthy process, so frequent monitoring is necessary and recommended.
What are the symptoms of rapid cycling bipolar disorder?
- Manic episode symptoms
- Depressive episode symptoms
- Suicide prevention
What is fast cycling?
Rapid cycling bipolar disorder is a term used to describe bipolar disorder characterized by four or more distinct mood episodes that may alternate between mania and depression over the course of a year. For context, bipolar disorder is usually associated with one or two episodes per year.
There are four types of bipolar disorder:
- bipolar 1
- bipolar 2
- cyclothymic disorder
- other bipolar and related disorders, including cases of bipolar disorder that do not fit into the three types listed above.
Rapid cycling is not a type of bipolar disorder or a formal diagnosis. It simply refers to a specific course of the condition associated with more frequent and faster mood swings.
For some, the fast cycling may be temporary, but for others, the pattern returns regularly.
What are the symptoms of rapid cycling bipolar disorder?
The main feature of rapid cycling is an unusually frequent transition from mania or hypomania to depression and back.
In bipolar 1, manic episodes last at least seven days less if they are severe enough to require hospitalization. In some cases, bipolar 1 disorder may also include depressive episodes. Mixed episodes are also possible, which include both manic and depressive symptoms at the same time.
In bipolar 2, depressive episodes alternate with hypomania rather than full-blown manic episodes.
Rapid cycling involves four or more episodes of any type within 12 months. These mood swings happen randomly and can last days or weeks.
Some may be much shorter or longer than others.
These fast cycle patterns vary from person to person. Some people start by riding a bike fast. For others, it happens gradually. Either way, this pattern of bipolar disorder can make it difficult for him to function.
Symptoms of manic episodes
Signs and symptoms of a manic episode may include:
- An increase in physical and mental energy
- Less need for a dream
- Anger, irritability
- 1 exaggerated sense of optimism and self-confidence
- grandiose thinking
Here is one person's account of a bipolar manic episode.
In severe cases, hallucinations and delusions (psychosis) may occur.
Symptoms of hypomania are the same, but less intense, without hallucinations and delusions.
Symptoms of depressive episodes
Signs and symptoms of a depressive episode may include:
- Constant Sorrow
- Crying Crying
- Pessimism, indifference of
- Lack of energy, Fatigue
- SPIRITIONS IN THE MU
- irritability, anxiety, agitation, anger
- feelings of worthlessness, hopelessness, or guilt
- lack of concentration, forgetfulness
- loss of interest in things you once enjoyed
- withdrawal from social situations
- alcohol or other substance abuse substances
- thoughts of death, self-harm or suicide
Five or more symptoms must be present within the same two-week period and represent a change from previous functioning; at least one of the symptoms must be either depressed mood or loss of interest or pleasure.
What causes rapid cyclic bipolar disorder?
Experts are not sure what causes bipolar disorder or rapid cycling. Among people with bipolar disorder, about 12 to 24 percent develop fast cycling at some point.
Anyone with bipolar disorder can develop rapid cycling. This can happen more in women than in men, but it's not entirely clear yet.
This may also be related to:
- severe bipolar disorder 1
- thyroid problems
- taking certain antidepressants
- history of substance use disorder
It may also be due to earlier onset and longer duration of illness.
How is rapid cycling bipolar disorder diagnosed?
Rapid cycling may take some time to be diagnosed because it requires at least four episodes per year. Part of the diagnostic criteria also includes at least two months between episodes.
Rapid cycle symptoms can be difficult to recognize, especially if one tends to spend more time in a depressed state.
As a result, rapid cycling may not be diagnosed or reported.
If you suspect you are experiencing fast cycling, try tracking:
- your daily mood
- medications
- Symptoms
- life events and stressors
- sleep
You can do this in a magazine, application, or chart. The Center for Quality Assessment and Mental Health Improvement has a detailed mood chart that you can download here.
You can also check out our list of the year's best apps for people with bipolar disorder, including mood trackers.
Take this information with you when you see your doctor for a diagnosis.
How to treat bipolar disorder with rapid cycling?
Bipolar disorder, including rapid cycling bipolar disorder, is treated with medication. But finding the right one can take some time.
Your doctor will work with you to find the right medicine or combination of medicines to treat your symptoms. During this time, they may make adjustments to your dosage and treatment plan from time to time.
Some types of drugs used to treat rapid cycling bipolar disorder include:
- mood stabilizers
- antidepressants
- atypical antipsychotics
Any antidepressants you are already taking may need to be adjusted or stopped. It may also take more than one medication to bring the symptoms under control.
Although lithium mood stabilizer is often used to treat bipolar disorder, it may not be useful for people who experience rapid cycling. Valproic acid, an anticonvulsant, may be more effective for fast cycling.
It is important to carefully follow the instructions for these medicines. Stopping them or changing the dosage without consulting your doctor can lead to serious unforeseen side effects.
Other treatments that may help include:
- psychotherapy
- medication to help you sleep
- electroconvulsive therapy
While these treatments may help, your doctor will likely still recommend medication.
Using medication to manage your symptoms while trying these treatments can make it easier to fully participate and reap their potential benefits.
Are there any tips for dealing with bipolar disorder with rapid cycling?
Rapid cycling bipolar disorder is a serious condition that can increase the chance of suicide. That's why it's so important to follow your treatment plan and keep your doctor informed about your symptoms and state of mind.
If you can't afford treatment, the American Anxiety and Depression Association offers resources for finding low-cost therapies and prescription drugs.
It may also be helpful to find a support group online or in person to connect with others who are experiencing similar problems. The Depression & Bipolar Support Alliance allows you to search for groups in your area, as well as join online groups.
Other things that can help include:
- avoid alcohol and drugs not prescribed by your doctor, as they can make things worse
- trust a close friend or family member when you feel you are acting recklessly or exposing self danger
- maintaining a daily routine, such as waking up and going to bed at the same time to episode
- Seek medical attention as soon as symptoms worsen
Suicide Prevention
- If you think someone is at immediate risk of harming themselves or harming another person:
- • Call 911 or your local emergency number.
- • Stay with the person until help arrives.
- • Remove all weapons, knives, medicines, and other items that could cause harm.
- • Listen, but don't judge, argue, threaten, or yell.
- If you or someone you know is thinking about suicide, get help from a crisis or suicide prevention hotline. Call the National Suicide Prevention Hotline at 800-273-8255.
How can I support someone with rapid cycling bipolar disorder?
If someone you care about has bipolar disorder with rapid cycling, there are a few things you can do to support them. When offering help, try not to sound judgmental, even if something they did bothers or annoys you. Most likely, their behavior is a symptom of their condition, and not something personal against you.
Other tips include:
- have a list of your medications and doctors handy in case of an emergency
- offer help when you notice early warning signs of mania or depression
- remain calm if they are angry or arguing
- call emergency services if they seem in danger situations
First of all, try to listen to their feelings and concerns.
