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.
Any type of bipolar disorder can be rapid cycling. It is thought between 10% -20% of people with bipolar disorder rapid cycle.2
Understanding Rapid Cycling Bipolar Disorder
Bipolar disorder is characterized by episodes of depression and either mania or hypomania, as in the case of bipolar type 2. According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), episodes must last a minimum length of time:
- 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. On average, people have between 0.4-0.7 episodes per year, lasting three to six months.1 Between episodes, there may be periods of normalcy (without an elevated or depressed mood). Rapid cycling bipolar disorder is the dramatic speeding up of these cycles.
(Read more on the diagnosis of bipolar disorder.)
Rapid Cycling Bipolar Disorder Symptoms and Effects
While the DSM-IV-TR only defines one type of rapid cycling, particularly short cycles are also known to occur. Ultra-rapid cycling denotes episodes only lasting days and ultradian indicates multiple episodes per day.
Rapid cycling bipolar disorder can be more difficult to detect than standard bipolar disorder as patients, particularly those with a short hypomanic cycle, may see the hypomania as simply a rare "good mood" rather than an actual mood episode. 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.
Treatment of Rapid Cycling Bipolar Disorder
People who experience rapid cycling bipolar are hospitalized more often and their symptoms are usually more difficult to control over the long term.
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.
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 with the aim to stop the cycling and then bring the mood up, if needed. Common mood stabilizers used in the treatment of rapid cycling bipolar disorder include:3
- Anticonvulsants like valproic acid (Depakote) or Carbamazepine (Tegretol)
- Antipsychotics, normally newer generation antipsychotics like Quetiapine (Seroquel) or Aripiprazole (Abilify)
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. Antidepressants are typically tapered once the depression is under control.
One medication, Symbyax, is a combination of Olanzapine (Zyprexa) and fluoxetine (Prozac). This combination of an antipsychotic and an antidepressant may be useful in improving depressive symptoms without destabilizing mood.