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A Layperson's Description of Rapid Cycling Bipolar Disorder

By Kaduna

Updated May 24, 2008

The term rapid cycling describes many different patterns of cycling. The underlying illness, bipolar disorder, manifests in episodes of mania and depression. But the pattern of cycles, the course of illness, is not fixed. It can be changed for the worse by many factors: drinking, street drugs, stressors, other medical illnesses, etc. The course of illness can also be improved by many factors: appropriate drugs, therapy, groups, this website. The course of illness is different in everyone, and the goal of treatment is to improve your course of illness. Rapid cycling is one example of a particularly poor course of illness.

The official definition of rapid cycling is four or more distinct episodes of depression and hypo/mania a year. But the original understanding was that there are periods of normal mood between episodes. In other words, the episodes were rapid, accelerated, coming faster, but were separated in time, with normal mood periods in between. There are, however, more complex versions of rapid cycling. Bipolar literature is extremely confused about the terminology, and the term rapid cycling is used to mean very different things.

If you go from one episode DIRECTLY into another type of episode, with no normal mood period in between, this is a "switch," which is usually considered worse than just plain rapid cycling. Again, I am talking about the original description of rapid cycling. Nowadays, all kinds of different patterns of illness are all mixed up together under the heading of "rapid cycling."

For example, you could have depression in January, be okay from February to May, get hypomanic in June, be fine in July, depressed from August to October, okay in November and depressed in December. This is four episodes a year and qualifies as rapid cycling. Let's call this "plain" rapid cycling, episodes separated in time.

But a second pattern might be: you are depressed in January and go directly into mania in February - a "switch." You are then okay from March to October, get depressed in November, and switch to mania in December. This also gives you four episodes a year, to qualify as rapid cycling. But this second pattern is very different from the first, and may have different causes and treatments. In the second pattern, there are two switches.

Still another pattern would be having, in one year, a switch and then two episodes separated in time.

In other words, the term "rapid cycling" as currently used is too broad and includes many possible variations in course of illness and patterns of cycling. As such, this term is not useful in describing the specifics of your own particular course of illness. It obscures the real differences in patterns of cycling, which may be important in trying to figure out what is going on.

Now, there are still other issues: if you have one switch, that is, go from depression DIRECTLY to mania, but then have a normal mood episode, this is a "switch" or "biphasic" cycling.

If you go from depression DIRECTLY to mania, then continue DIRECTLY to depression again, this is "multi-phasic" cycling, worse than plain rapid cycling or even a plain or single "switch." But even "multiphasic" can end at some point, say with three or five DIRECT switches into other mood states, then a period of normal mood.

Worse even than multiphasic is "continuous" cycling, which means that you never have a normal mood period: you cycle directly from one mood state into another with no normal mood. But again, the mood episodes may be long, short, mixed, with added features of panic, anxiety, etc. I guess the worst is ultra-rapid cycling and ultra-ultra-rapid or ultradian cycling, with many episodes in a day which just go on and on. It is very important to understand these differences, and write down all your moods and drugs, EVERY DAY. Otherwise, you will never figure out what is going on.

Some of these patterns, especially switches, may be caused by drugs. We know about some causes of "switches." It is well known and understood and appears in the APA "Practice Guideline for the Treatment of Patients with Bipolar Disorder" that antidepressant drugs (ADDs) cause switches to mania, cycle acceleration and thereby, rapid cycling.

This is not controversial. There have been many articles advising using ADDs for as short a period as necessary and in as low a dose as necessary. Of course, we know that everybody is on ADDs anyway. One problem: discontinuing ADDs (including SSRIs) may lead to a withdrawal syndrome, making you feel worse, and then you go back on ADDs (see SSRI Discontinuation Syndrome).

Next: Do any other drugs cause rapid cycling or destabilize/accelerate the cycles? >>

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