Bipolar blogger Natasha Tracy offers exclusive insight into the world of bipolar disorder.See all posts »
How Often Do Moods Cycle in Bipolar Disorder?
Bipolar disorder consists of mood episodes. It is comprised of depression, manic/hypomanic, mixed, and euthymic (normal) moods. But how long do moods last and how often do moods change?
Moving from one mood to another is known as cycling. Bipolar mood episodes can last for days, weeks, months, or even longer so cycles can take various amounts of time, too. In classic bipolar disorder, people have three or less mood episodes (not including euthymia) per year. A typical example might be one moth of mania followed by three months of depression and then the rest of the year spent euthymic.
Rapid Cycling Bipolar Disorder
However, while this is classic bipolar disorder, there are many people who cycle more than three times per year and this is called rapid cycling bipolar disorder.
In this case moods are likely to last weeks or months. It’s estimated 12-24 percent of patients at specialized mood disorder clinics rapid cycle. Rapid cycling is more common in women and in type II bipolar disorder.
Unfortunately, people with rapid cycling bipolar disorder tend to have longer illness durations and greater illness severity. Rapid cycling may be a state that is transient for some people.
Ultra-Rapid and Ultradian Bipolar Disorder
Beyond that, some people cycle even more frequently and this is known as ultra-rapid cycling. Ultra-rapid cycling has moods that last between days to weeks. There is a small subset of people whose moods last between hours to days and this is known as ultradian cycling. (The Diagnostic and Statistical Manual of Mental Disorders [DSM] does not recognize this course of bipolar disorder as the moods do not meet the minimum durations set in the manual, but clinically, this course is acknowledged.)
When moods last only hours it can be difficult to distinguish them from natural emotions but in some cases such major emotional shifts are seen that it becomes clear they are major mood episodes and not standard states. This is commonly seen in children with bipolar disorder.
Handling Rapid Cycling
Handling rapid cycling versions of bipolar disorder comes with special challenges and people experience what I call “mood whiplash” when moods change so drastically, so quickly. It’s difficult enough to deal with a mood episode that’s predictable let alone one that comes along at the blink of an eye. These types of mood changes feel like a punch in the gut and people suffering from rapid cycling are always on the lookout for clues that their mood is changing. This work is exhausting.
Treating Rapid Cycling Bipolar Disorder
Treating the rapid cycling variants of bipolar disorder can often be even more challenging than the standard variety. The goal is, typically, to first stop the cycling and then adjust the mood, if needed.
There is a scarcity of data on treating rapid-cycling bipolar disorder but there is some evidence to suggest the use of:
- Carbamazepine (Tegretol)
- Valproate (Depakote)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
- Gabapentin (Neurontin)
- Primidone (Mysoline)
- Nimodipine (Nimotop)
- Olanzapine (Zyprexa)
- Venlafaxine (Effexor) (when current mood is depressed)
- Thyroid-elevating medications
A therapy that controls light and darkness known as dark therapy may also be effective.
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