What Is Rapid-Cycling Bipolar Disorder?

Rapid moods swings linked to disability and suicide risk

depressed man in bed
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Rapid cycling is a term used when a person with bipolar disorder experiences four or more mood swings (episodes) within a twelve-month period. An episode may consist of depression, mania, hypomania, or a condition known as a mixed state in which depression and mania are co-occurring.

Most people with bipolar disorder will alternate between manic and depressive episodes once or twice a year. Others may only experience this once every few years. However, a small subset of people will undergo what is called rapid cycling in which the mood swings come fast and frequently.

Rapid cycling is considered one of the more severe form of bipolar disorder, the condition of which can seriously impair your ability to function as well as your quality of life.

Characteristics

Rapid-cycling bipolar disorder is characterized by mood swings that are random and unpredictable. There is usually no set pattern as to when an episode might occur and what form it may take. In some cases, the episodes may cycle every few months; in others, the cycling may occur monthly or weekly.

Rapid cycling itself is not a diagnosis per se but rather a description of the course of the illness. Similarly, the symptoms of rapid cycling are no different than any other form of bipolar disorder, only the speed by which they alternate.

We don't know why rapid cycling occurs and whether it will be an ongoing pattern or one that will eventually resolve. While some rapid cyclers will often alternate between depression and hypomania (a less severe form of mania), most cases will be dominated by distinct episodes of depression. The cycling itself can often be hard to recognize, either because an episode was mixed or the hypomania state has become shorter and less obvious.

Rapid cycling may, in some cases, be a precursor to more severe manifestations of the disease, including psychosis. This is more often seen in people with bipolar I disorder than the less-severe bipolar II disorder.

Risk Factors

Statistically speaking, between five percent and 10 percent of people with bipolar disorder will meet the diagnostic criteria for rapid cycling. While scientists have yet to pinpoint the cause of the condition, they have identified a number of common risk factors.

Among them:

  • Women appear to be at a higher risk than men, which some believe may be attributed to hormonal fluctuations during the menstrual cycle.
  • People who develop bipolar symptoms in their teens are more likely to become rapid cyclers.
  • A long history of depression is also a common risk factor.

Some studies have also suggested that the long-term use of antidepressants may contribute. This may explain, in part, why people diagnosed in their teens are at greater risk given that they are more likely to be exposed to antidepressants for many years.

Other studies suggest that low thyroid function play a part given that rapid cyclers are far more likely to be diagnosed with hypothyroidism. Since the thyroid gland plays a central role in the production of hormones, including those associated with premenstrual syndrome (PMS), it is likely that hormones contribute, at least in part, to the rapid cycling of moods.

Impact on Quality of Life

Rapid-cycling bipolar disorder not only places individuals at greater risk of alcohol and substance abuse, it increases the likelihood of suicide and self-harm. A 2009 study from the University of Barcelona concluded that, as an independent risk factor, rapid cycling was associated with a nearly two-fold increase in the number of suicide attempts compared to non-rapid cyclers.

Even if suicide is not part of the picture, rapid cycling will almost certainly undermine a person's quality of life. Most affected will be unable to maintain or commit to a set schedule given the high variability of their mood state. Their job performance will typically suffer, and they may end up being hard to rely on, professionally or personally. Unless there are some means to curtail the mood swings, a rapid cycler will usually find it difficult to get or keep a job.

Treatment Options

Almost without exception, rapid-cycling bipolar disorder is more difficult to treat than non-rapid-cycling bipolar disorder. With that being said, much of the focus will be placed on stabilizing the symptoms of depression given that they will usually dominate the picture.

By and large, antidepressants such as Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline) have proven ineffective in breaking the cycle and may, in fact, only increase the speed by which they occur.

Mood stabilizers have proven far more effective, particularly if they are used in combination with an antipsychotic to manage symptoms of mania/hypomania.

If you have not been previously treated for bipolar disorder, you may be placed on lithium in first-line treatment. For all others, Depakote (valproate), Lamictal (lamotrigine), or Tegretol (carbamazepine) would likely be prescribed. To support therapy, the antipsychotics Seroquel (quetiapine) or Zyprexa (olanzapine) may be used.

Mood stabilizers may be prescribed indefinitely to prevent future episodes. If antidepressants have bee n used, they would be stopped as soon as the depressive episode is resolved.

A Word From Verywell

If you are being treated for rapid-cycling bipolar disorder, it is important to be patient and take it one step at a time. Find the right combination of drugs can be a process of trial and error, and it may take several attempts before your doctor finds the combination that's right for you.

Moreover, once treatment is started, it may take several months before you begin to feel the full benefits of therapy. To this end, it is important to seek support, attend support groups, and to continue working with your therapist until you are able to gain better control over your mood swings.

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