What Is Rapid Cycling Bipolar Disorder?

depressed man in bed
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Rapid cycling, according to the American Psychiatric Association's Diagnostic and Statistical Manual, occurs when a person experiences four or more mood swings or episodes in a twelve-month period. An episode can consist of depression, mania, hypomania or even a mixed state.

Most people with bipolar disorder alternate between manic moods and depression, typically a few times each year.

But in the form of rapid cycling bipolar disorder, these mood swings can occur much more rapidly. Rapid cycling bipolar disorder is considered to be a more severe form of bipolar disorder.

People who have at least four mood "episodes" (times where they're in hypomanic, manic, depressed or in a mixed state) over the course of a year are considered to have rapid cycling bipolar disorder. However, in some "rapid cyclers," the mood swings can come even more quickly — weekly, daily or even hourly.

Rapid cycling bipolar disorder can feel like an out-of-control, mood-driven roller coaster for someone who has it. People who have rapid cycling bipolar disorder are more likely to attempt suicide than those with bipolar who don't cycle through moods so rapidly.

Who's at Risk for Rapid Cycling Bipolar Disorder?

Most people are diagnosed with bipolar disease in their late teens or early 20s. Those who are diagnosed with bipolar disorder at a slightly younger age — potentially in their mid-teens to late teens — are more likely to be rapid cyclers.


In addition, women appear to be at a higher risk for rapid cycling than men, although researchers aren't certain why this is so. It's also possible that the use of antidepressants may trigger rapid cycling, and some studies have implicated low thyroid function as another possible contributor.

It's not clear how many people suffer from rapid cycling bipolar, but some studies estimate that as many as one-third of all bipolar patients may have it during any given year, and between 26% and 43% of all bipolar patients may have it sometime during the course of their illnesses.

While some people can be diagnosed with bipolar and move immediately into rapid cycling, most find rapid cycling of moods creeps up on them gradually, especially if their bipolar disorder isn't managed well. It's also common to move in and out of rapid cycling, so those who experience it likely won't have it forever.

Symptoms of Rapid Cycling

Rapid cycling bipolar disorder is diagnosed when you've had more than four mixed states, hypomanic, manic or depressive mood episodes in a year. The mood swings tend to be random and unpredictable.

Those with rapid cycling bipolar disorder may be particularly impulsive, irritable and angry. They may have outbursts that aren't easily controlled. People with rapid cycling are at higher risk for suicide, drug and alcohol abuse.

Fortunately, most people with rapid cycling bipolar disorder stop cycling so rapidly after a year or so of treatment. However, those who continue to rapid cycle after a year, even with treatment, may suffer from the cycle for many years.

Treatment for the Condition

It's more difficult to treat rapid cycling bipolar disorder, especially to the point where the person's moods are completely stable. It can be challenging to find the right combination of medications, and you and your psychiatrist may have to try several different combinations to identify one that works well.

In addition, you have to be patient, since medications may take several months to take full effect.

People who haven't taken medications before for their illness usually start with lithium. Lamictal (generic name: lamotrigine), Tegretol (generic name: carbamazepine), and Depakote (generic name: valproate) also can be used to treat rapid cycling bipolar disorder. Zyprexa (generic name: olanzapine) has shown benefits in some studies in combination with other medications.


Carvalho AF et al. Rapid cycling in bipolar disorder: a systematic review. The Journal of Clinical Psychiatry. 2014 Jun;75(6):e578-86.

Coryell W. Rapid cycling bipolar disorder: clinical characteristics and treatment options. CNS Drugs. 2005;19(7):557-69.

Depression and Bipolar Support Alliance. Rapid Cycling and Its Treatment fact sheet. 

Garcia-Amador M et al. Suicide risk in rapid cycling bipolar patients. Journal of Affective Disorders. 2009 Sep;117(1-2):74-8.

National Institute of Mental Health. Bipolar Disorder fact sheet.