• the typical course of manic/depressive episodes and how fast a “rapid cycler” switches poles

by Tad Halvorson 4 min read

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.

Full Answer

What is the frequency of bipolar disorder cycles?

Frequency of Bipolar Cycles. The frequency and duration of cycles are as varied as the individuals who have them. This change or “mood swing” can last for hours, days, weeks, or even months. Typically, someone with bipolar disorder experiences one or two cycles a year, with manic episodes generally occurring in the spring or fall.

How often do people with bipolar disorder have manic episodes?

Some 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 have rapid cycling, in which the mood swings come fast and frequently.

Does rapid cycling mean multiple episodes of bipolar disorder?

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.

How fast do moods change in bipolar disorder?

In rapid cycling, moods change quickly, with at least 4 distinct mood episodes per year. Bipolar disorder is a lifelong condition that most commonly appears for the first time

How fast is rapid cycling bipolar?

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.

How fast can bipolar moods switch?

Unfortunately, there is no definitive answer to how often these cycles occur. The frequency and duration of bipolar cycles are as varied as the people who experience them. A change or "mood swing" can last for hours, days, weeks, or even months.

How often do bipolar episodes switch?

Many people with bipolar disorder will experience two cycles per year, according to the Depression and Bipolar Support Alliance. When someone has four or more manic, hypomanic, or depressive episodes in a 12-month period, this is called rapid cycling.

Can bipolar turn into rapid cycling?

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.

Can bipolar change in minutes?

It's common to experience a change in mood occasionally or to go through a short period of feeling elated or blue. But if your behavior is unpredictable for a number of days or longer, it may be a sign of something more serious. You may feel grumpy one minute and happy the next.

What is ultra rapid cycling bipolar?

While 12% to 24% of patients with bipolar disorder experience rapid cycling (a total of 4 or more mood episodes in a year), ultradian is characterized by multiple episodes in a day. Some psychiatrists would prefer to classify it as a mixed state.

What causes bipolar episodes to switch?

Switching from depression to mania/hypomania can occur spontaneously over the course of the illness, but can also be precipitated by stress, sleep deprivation, or standard treatment for bipolar depression such as electroconvulsive therapy (ECT) and some antidepressants5, 6 (see below), as well as various other agents ( ...

Can manic episodes last a few hours?

Keeping health in mind These highs don't last as long. While they are officially diagnosed after a four day duration, research has shown that they may only last a few hours to a few days.

How short can manic episodes be?

A true manic episode lasts for one week or more, often includes psychotic symptoms and sometimes requires hospitalization. However, the researchers noted that most people with bipolar disorder experience hypomania rather than mania.

What triggers rapid cycling?

Rapid cycling is a symptom of some bipolar patients that causes them to cycle through four or more episodes a year. Rapid cycling may be caused by substance abuse, severe life stressors, or trauma. Stopping medication, using antidepressants, and sleep disturbances can trigger rapid cycling.

How long do manic episodes last?

Early signs (called “prodromal symptoms”) that you're getting ready to have a manic episode can last weeks to months. If you're not already receiving treatment, episodes of bipolar-related mania can last between three and six months. With effective treatment, a manic episode usually improves within about three months.

What is rapid cycle bipolar?

It’s a literal rollercoaster where the emotional ‘highs’ are very high, and the ‘lows’ are dangerously low.”.

How many manic episodes are there for bipolar?

To have a diagnosis of bipolar disorder, a person must only experience one manic episode. Depression may never occur with bipolar disorder, despite the name. Many people with bipolar disorder will experience two cycles per year, according to the Depression and Bipolar Support Alliance. When someone has four or more manic, hypomanic, ...

What is a high mood episode?

Share on Pinterest. A high mood is one aspect of bipolar mania, but there are other features, too. A manic episode is a period of elevated, enthusiastic, or irritable mood lasting at least 1 week. It will include at least three of these symptoms: a high mood. high levels of physical and mental activity and energy.

How many people with bipolar experience rapid cycling?

According to the Mood Disorders Association of Ontario, around 10–20 percent of people with bipolar disorder experience rapid cycling. Between 70–90 percent of these are women. It can happen at any time during a person’s experience of bipolar disorder, and it can come and go. Not everyone with rapid-cycling will experience changes four times every ...

Why is it so hard to identify bipolar?

in young adults. Symptoms may occur during adolescence, but it can be difficult to identify, because mood changes are common at this stage of development. Apart from mood, bipolar disorder also causes changes in energy levels and behaviors known as cycles. To have a diagnosis of bipolar disorder, ...

What gene plays a role in the core clock that produces circadian rhythms?

Trusted Source. of a study, published in 2010, of genetic features in people with rapid-cycling bipolar disorder. The scientists found changes in CRY2, a gene that plays a role in the core clock that produces circadian rhythms.

What does bipolar feel like?

On the outside, they may simply look like extreme highs and lows. The person who experiences these changes, however, may also be having irrational thoughts and sensations.

What is the circadian rhythm?

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.

What is rapid cycling?

Rapid Cycling. 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.

How to help people with rapid cycling?

Talk Therapy. Talk 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.

What is it called when you have four mood changes in a month?

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.

Can bipolar people cycle?

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.

Can rapid cycling be treated?

Treatment for Rapid Cycling. 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.

When do bipolar cycles start?

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.

Why is it so hard to identify rapid cycling bipolar disorder?

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.

How long does bipolar last?

The major features of bipolar disorder include: 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.

What are the symptoms of bipolar disorder?

The major features of bipolar disorder include: 1 At least 1 episode of mania or hypomania in the patient's lifetime 2 Episodes of depression (major depressive disorder), which are often recurrent

What is rapid cycling?

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;

What is the best treatment for bipolar disorder?

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) ...

What is the best medication for rapid cycling?

Mood-stabilizing drugs -- such as carbamaz epine ( 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.

What percentage of people with bipolar disorder have rapid cycles?

Any type of bipolar disorder can be rapid cycling. It is thought between 10% -20% of people with bipolar disorder rapid cycle. 2.

How long does it take to get over mania?

Four days for hypomania. One week for mania. Two weeks for depression. While those are minimum lengths of time, many people with bipolar disorder spend more, sometimes considerably more time in an episode.

What is the best mood stabilizer for bipolar?

Lithium. Anticonvulsants are typically the first choice mood stabilizers as both valproic acid and carbamazepine have been shown effective in treating rapid cycling bipolar disorder. If an antidepressant is used, it is used in combination with a mood stabilizer to prevent further cycling.

What are the symptoms of rapid cycling bipolar?

Since they spend more time depressed, they are often misdiagnosed with depression. The hallmark symptoms of rapid cycling bipolar are mood and energy changes that are out of control and disabling. The person may experience severe irritability, anger, impulsivity, and uncontrollable outbursts.

Is rapid cycling more common in bipolar disorder?

Rapid cycling is more common in people with type 2 bipolar disorder and people with bipolar 2 have been shown to spend 35 times more time depressed than hypomanic. Because of this, rapid cycling treatment tends to be focused around relieving the depression.

Is rapid cycling bipolar dangerous?

Rapid cycling bipolar disorder can be a dangerous condition and carries a high risk of suicide. When a person with bipolar experiences four or more manic, hypomanic, or depressive episodes in any 12-month period, it's defined as rapid cycling bipolar. While the term rapid cycling may make it sound as if the episodes occur in regular cycles, episodes actually often follow a random pattern. Because of the rapid mood swings associated with this type of bipolar disorder, the individual may feel as if they're on an emotional roller coaster; swinging from the highs of mania to the depths of depression -- all in the course of a few days or even hours.

Can antidepressants cause rapid cycling?

While antidepressants would seem to be the logical choice for treatment of a depressive episode, antidepressants can often make rapid cycling worse . Antidepressants for bipolar depression can induce cycling, create more rapid cycling or even induce a manic episode. Mood stabilizers are the preferred treatment for rapid cycling bipolar disorder ...

What is a cycle in bipolar?

In the context of bipolar disorder, a mental illness that involves extreme swings in mood, a cycle is the period of time in which an individual goes through one episode of mania and one episode of depression (or hypomania and depression).

How often do bipolar cycles occur?

Unfortunately, there is no definitive answer to how often these cycles occur. The frequency and duration of bipolar cycles are as varied as the individuals who have them. A change or “ mood swing ” can last for hours, days, weeks, or even months. Typically, someone with bipolar disorder experiences one or two cycles a year, ...

How long does bipolar last?

A 2010 study of people with bipolar 1 disorder found that mood episodes lasted an average of 13 weeks. 1  On average, people with bipolar will have one or two cycles yearly. In addition, there is a seasonal influence—manic episodes occur more often in the spring and fall. 1:47.

What are the symptoms of bipolar disorder?

Certain conditions are known to trigger symptoms in people with bipolar disease. Understanding these triggers—and avoiding them—can minimize symptoms and limit the number of cycles a person experiences. These include: 1 Insufficient sleep 2  2 Altercations with loved ones 3 Alcohol and drug misuse 4 Certain antidepressants and other medications 5 A change in seasons 6 Pregnancy and other hormonal conditions 7 Grief over the death of a friend or family member 8 Events such as starting a creative project, falling in love, going on vacation, listening to loud music, menstruation, and decreased physical exercise 3 

How often do bipolar people cycle?

Whether a person with bipolar disease experiences a cycle once every five years or many times each day, there are treatments that can help. These include: 5 . Medications, including mood stabilizers, antipsychotics, and antidepressants. Cognitive-behavioral therapy and other forms of psychotherapy.

What is ultrarapid cycling?

In addition, the term "ultra-rapid cycling" may be applied to those who cycle through episodes within a month or less. If this pattern occurs within a 24-hour period, the person's diagnosis could possibly be termed "ultra-ultra-rapid cycling" or "ultradian.".

Is rapid cycling a permanent pattern?

However, while having four or more cycles in a one-year period means meeting the criteria for a diagnosis of rapid-cycling bipolar illness , rapid cycling is not necessarily a permanent pattern. Rather, rapid cycling can present at any point in the course of the disease. And it can be transient.

What is rapid cycling?

Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling occurs in 10-20% of all people with bipolar disorder, and is more common in women (read this article for more facts about rapid cycling). Bipolar disorder varies greatly from person to person.

How many episodes of bipolar disorder in a year?

Similarly, rapid cycling can also mean different things for different people. To meet the clinical definition, there must be 4 episodes in a year. But some individuals can experience multiple mood shifts in the same day (for a visual depiction of this, check out the graphs in this article ).

Is rapid cycling random?

Rapid cycling can also vary in how consistent it is: some people see the same patterns year after year, and for others it seems to be random. In this article we will hear from 3 different perspectives: Melanie, who often experiences several cycles in the same day. Lauren, who’s rapid cycling changes throughout the year.

Does Rapid Cycling change minute to minute?

It doesn’t change minute to minute, but it sure feels that way! It really affects my energy levels and how I interact or want to interact with other people. Rapid cycling feels like your mind is playing tricks on you. You are sad one minute, hyper the next, giddy, and then back to sad, teary, and wanting to hide.

Do all people with bipolar experience this?

It seems that all people with bipolar would experience this, but they don’t. My brother, for example, has bipolar disorder and generally cycles once or twice a year (between hypomania and depression). The important thing to remember is that there are multiple types of bipolar disorder.

How long does a depressive episode last?

Duration criteria for episodes are not waived, which means that each major depressive episode must last at least 2 weeks, each manic or mixed episode must last at least 1 week, and each hypomanic episode must last at least 4 days.

What is rapid cycling?

DSM-IV defines rapid cycling as the occurrence of at least 4 major depressive, manic, hypomanic, or mixed episodes during the previous year in a patient with a diagnosis of BP I or BP II.

Does lithium affect rapid cycling?

Their conclusion was that lithium does have an impact on rapid cycling. The 1974 paper by Dunner and Fieve is always quoted in publications concerning treatment of rapid cyclers, whereas the 1977 paper is almost never mentioned.

Is manic remission higher in rapid cyclers?

The average duration of both manic and depressive episodes may be shorter in rapid cyclers than in non–rapid cyclers, so that the likelihood of a spontaneous remission during the treatment period may be higher in rapid cyclers.

Is rapid cycling a reliable definition?

These results suggest that the DSM-IV definition of rapid cycling, although very reliable, may not be sufficiently inclusive (ie, it may exclude patients with very short episodes of very high frequency, who are typical in terms of external validators and are currently regarded as rapid cyclers by many researchers and clinicians).

Is rapid cycler refractory to lithium?

A statement that is commonly made in the literature on bipolar disorder is that rapid cyclers are refractory to lithium prophylaxis. This notion dates back to the classic paper by Dunner and Fieve 8 in which the concept of rapid cycling was introduced. These investigators reported a failure of lithium prophylaxis in 82% of rapid cyclers and 41% of non–rapid-cycling bipolar patients, a statistically significant difference ( P < .05). However, their comparison was actually flawed. In fact, failure of lithium prophylaxis was defined as the occurrence of at least 1 new episode during an observation period of at least 6 months, not considering that rapid cyclers are by definition more likely than non–rapid cyclers to have a new episode during any observation period, whether or not they are treated.

Characteristics of Rapid Cycling Bipolar Disorder

Risk Factors For Rapid Cycling

  • Some estimates are that between 5% to 10% of people with bipolar disorder will meet the diagnostic criteria for rapid cycling.1While scientists have yet to pinpoint the cause of the condition, they have identified a number of common risk factors. 1. Sex: Women appear to be at a higher risk than men, which some believe may be attributed to hormonal ...
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Impact on Quality of Life

  • Rapid-cycling bipolar disorder not only places individuals at greater risk of alcohol and substance abuse, but it also 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-r…
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Treatment Options

  • Almost without exception, rapid-cycling bipolar disorder is more difficult to treat than non-rapid-cycling bipolar disorder. But certain medications may be helpful. Antidepressantssuch as Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline) have proven ineffective in breaking the cycle. These drugs may actually increase the speed at which cycles occur. Mood stabilizers hav…
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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. Finding 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 some time before you begin to feel the full bene…
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