Rapid Cycling

On this page:
Signs & symptoms
Treatment options
Print resources
Online resources

Before you read this fact sheet you may want to read our fact sheet on bipolar disorder first.

Rapid cycling is a specific characteristic of bipolar disorder that may occur in as many as half of all people with bipolar disorder. The essential feature of rapid cycling is the occurrence of four or more mood episodes during the previous 12 months. Mood episodes include depression, mania, mixed state or hypomania. These episodes can occur in any combination and order but must be separated by a period of full remission or by a switch to an episode of the opposite polarity. People who experience rapid cycling compare it to a rollercoaster ride, with mood changes that seem uncontrollable.

There are two sub-types of rapid cycling:

Ultra-rapid cycling - when episodes occur monthly or more frequently
Ultradian rapid cycling - when episodes occur several times in one week or even in one day (also called ultra-ultra-rapid cycling).

Personal voices
"It was sort of unreal and frightening at the same time. I would have these shifts in mood that would catch me off guard, sometimes every day, and I became this person I hardly knew and barely liked. I was so confused and irritable. I can't imagine what it must have been like for my parents." (Cathy, 19)

People experience rapid cycling in varying patterns. It's important to learn the signs that signal the approach of an episode in you. Taking control can empower you and decrease feelings of helplessness and hopelessness, which often occur in depression. When you take action to reduce stimuli and irritability in your life, you may also decrease the severity of an episode.

Signs and symptoms

Mania

Elevated, expansive mood.
Extreme irritability.
Rapid, unpredictable emotional changes.
Racing thoughts, flights of ideas.
Overreaction to stimuli, misinterpretation of events.
Increased interest in activities.
Overspending.
Sense of grandiosity, inflated self-esteem.
Excessive energy.
Decreased need for sleep.
Increased sexual drive, sexual indiscretions.
Poor judgment.

Depression

Sad mood.
Preoccupation with failures or inadequacies and a loss of self-esteem.
Feelings of uselessness, hopelessness, excessive guilt.
Slowed thinking, forgetfulness, difficulty in concentrating and in making decisions.
Loss of interest in work, hobbies, people.
Social isolation.
Lethargy.
Agitation/Irritability.
Changes in appetite or weight (eating too little or too much).
Changes in sleep (sleeping too little or too much).
Decreased sexual drive.
Suicidal thoughts.

Facts about rapid cycling

70%-90% of individuals with a rapid-cycling pattern are women, while the rates of bipolar disorder are equal between men and women.
The mood episodes are not linked to any phase of the menstrual cycle and occur in both pre-and postmenopausal women.
Rapid cycling may be associated with hypothyroidism, certain neurological conditions (e.g. multiple sclerosis), developmental delay or head injury.
Rapid cycling can occur at any time during the course of bipolar disorder especially after the use of tricyclic antidepressant drugs.
Rapid cycling may be linked to substance abuse.
Rapid cycling can often lead to destructive behaviour and can negatively impact your personal relationships.

Treatment options

It can be challenging to find an effective treatment for rapid cycling. Traditional medications (such as lithium) used to treat bipolar disorder are not always effective. Don't give up, there are different options and combinations that you may need to try before you find the one that works best for you.

Sometimes, it's difficult to be completely objective about how you are doing. Input from those people who know you well can be helpful. Your friends and family can give support and notify your health practitioner when you are having difficulty. Using a mood tracking diary can be really helpful and an important tool in your recovery. It will provide you and your doctor with a better idea of how your treatment is managing your symptoms. The information obtained from mood tracking is valuable in helping to determine whether your medication and/or therapy has had an effect on your mood. Click here to download a printable copy of Personal Diary - Mood Tracker.

It is important to know that taking antidepressants can trigger manic/rapid cycling episodes in people who have bipolar disorder. If you are seeking treatment, it is very important to discuss any symptoms of mania or any family history of bipolar disorder with your health care practitioner.

For a list of places where you can get treatment and/or find a doctor, click here.

If you aren't sure where to begin, you can learn more about your choices and figure out which treatments might be best for you. To learn more click here.

Print resources

A Brilliant Madness by Patty Duke and Gloria Hochman. New York : Bantam Books, 1992.
A Mood Apart: Depression, Mania, and Other Afflictions of the Self by Peter C. Whybrow, M.D. Basic Books, 1997.
An Unquiet Mind by Kay Redfield Jamison. New York : Random House, 1995.
Mood Genes: Hunting for Origins of Mania and Depression by Samuel W. Barondes, M.D. New York, W.H. Freeman and Co, 1998.

Online resources

Rapid Cycling Bipolar Disorder http://www.bipolarworld.net/Bipolar%20Disorder/Articles/cycling.html

Treatment of Bipolar Disorder: A Guide for Patients and Families, Kahn/Keck/Perlis/Otto/Ross (2004). http://www.psychguides.com/Bipolar%20Handout.pdf

Bipolar Disorder: Rapid Cycling and Its Treatment http://www.dbsalliance.org/pdfs/rapidcycling.pdf

Circadian Rhythms Factor in Rapid-Cycling Bipolar Disorder
http://www.psychiatrictimes.com/p960533.html

Canmat 2005 Guidelines for the Management of Patents with Bipolar Disorder

http://www.canmat.org/resources/PDF/Bipolar_Guidelines.pdf

What is Rapid Cycling Bipolar Disorder
http://www.depression-guide.com/rapid-cycling-bipolar-disorder.htm

Sources