Frequently Asked Questions - Rapid Cycling

The essential feature of rapid cycling bipolar disorder is the occurrence of four or more mood episodes during the previous 12 months, according to the Diagnostic & Statistical Manual of Mental Disorders IV (DSM IV). These episodes can occur in any combination and order. However, the episodes of major depression, mania, mixed or hypomanic episodes must be separated by a period of full remission or by a switch to an episode of the opposite polarity.

Rapid cycling occurs in approximately 10 to 20% of individuals with bipolar disorder. Although the gender ratio is equal for bipolar disorder, women make up 70 to 90% of individuals with a rapid cycling pattern. The mood episodes are not linked to any phase of the menstrual cycle and occur in both pre- and post-menopausal women.

If you have a family member with rapid cycling bipolar disorder, you may be slightly more likely to develop
it yourself.

Rapid cycling may be associated with hypothyroidism, certain neurological conditions (eg. multiple sclerosis), developmental delay or head injury. Rapid cycling can occur at any time during the course of bipolar disorder and may appear and disappear.

Symptoms of depression include:

• Sad mood
• Preoccupation with failures or inadequacies
• Loss of self-esteem
• Slowed thinking, forgetfulness
• Difficulties in concentrating and in making decisions
• Loss of interest in work, hobbies, people
• Social isolation
• Lethargy or agitation
• Changes in appetite—eating too little or too much
• Oversleeping or insomnia
• Decreased sexual drive
• Suicidal thoughts

Symptoms of mania include:

• 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-esteems
• Excessive energy
• Decreased need for sleep
• Increased sexual drive, sexual indiscretions
• Poor judgment

• Write down any symptoms you’ve had
• Write down key personal information
• Make a list of all medications you are taking
• Write down questions to ask your doctor
• Take a family member or friend along

Discuss all of your symptoms with your doctor and describe how they are affecting your life (e.g. racing thoughts that cause you to lose focus and not get things done). Your doctor can suggest or provide appropriate therapy. Make sure to discuss all of the available treatments and medications and their benefits and side effects before making any decisions

It can be challenging to find an effective treatment for rapid cycling. Lithium, often used to treat bipolar disorder, is effective in about 20 to 40% of people with rapid cycling. Anti-convulsant medication (such as Valproic Acid) has been effective in the treatment of lithium-resistant rapid cycling and mixed states. Certain atypical anti-psychotic medications can also be helpful in treating people with rapid cycling bipolar disorder. Talk to your doctor about your individual treatment plan.

Antidepressant medications, particularly tricyclics, may provoke rapid cycling. Psychotropic medications should be tapered off gradually under the supervision of your doctor.

Complementary treatments, such as peer support groups or other support programs, may be helpful.

Rapid cycling can often lead to turbulent behaviour and disturbed relationships. People experience rapid cycling in varying patterns. Individuals can observe themselves for signs that signal the approach of their episodes of depression or hypomania/mania. This is empowering and the knowledge gained decreases feelings of helplessness and hopelessness which often occur in depression. Prompt action taken to reduce stimuli and irritability may also decrease the severity of the episode.

Sometimes, it is 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. Notify your physician when you are having difficulty.

• Prepare yourself for episodes of illness by learning about rapid cycling.
• Discuss difficulties and successes with peers in a support group. You are not alone. 
• Sleep and rest are important. It is important to stabilize sleep, reduce or stop the use of caffeine, nicotine, alcohol and substances. Establish a bedtime routine. Rest when tired.
• Use relaxation techniques, affirmations or spiritual material.
• Tell yourself frequently when distressed that change is inevitable in rapid cycling. You got through episodes in the past and you will be able to do it again.
• Don’t pressure yourself with criticism and unrealistic expectations.
• Stay away from overstimulating situations. Keep your life simple and ask for assistance if you need it.
• Stay in touch with family, friends and community support.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), fourth edition, American Psychiatric Association, 2000

Bipolar: Rapid Cycling and its Treatment

Rapid Cycling by Colleen Sullivan