What is rapid cycling?

Rapid cycling bipolar disorder is a term used to describe bipolar disorder that’s marked by four or more distinct mood episodes, which may alternate between mania and depression, in a year. For context, bipolar disorder is usually associated with one or two episodes per year.

There are four types of bipolar disorder:

  • bipolar 1
  • bipolar 2
  • cyclothymic disorder
  • other bipolar and related disorders, which includes cases of bipolar disorder that don’t fit into the three types listed above

Rapid cycling isn’t a type of bipolar disorder or a formal diagnosis. It just refers to a specific course of the condition involving more frequent, rapid mood swings.

For some, rapid cycling may be temporary, but for others, the pattern regularly returns.

The main symptom of rapid cycling is the unusually frequent transition from mania or hypomania to depression and back again.

With bipolar 1, manic episodes last at least seven days fewer if they are severe enough to require hospitalization. Bipolar 1 may also include depressive episodes in some cases. It’s also possible to have mixed episodes that include symptoms of mania and depression at the same time.

With bipolar 2, depressive episodes alternate with hypomania rather than full-fledged manic episodes.

Rapid cycling involves having four or more any kind of episode within a period of 12 months. These mood swings happen randomly and can last for days or weeks. Some may be much shorter or longer than others.

These patterns of rapid cycling vary from person to person. Some people start out with rapid cycling. For others, it comes on gradually. Either way, this pattern of bipolar can make it difficult to function.

Symptoms of manic episodes

Signs and symptoms of a manic episode can include:

  • increased physical and mental energy
  • less need for sleep
  • anger, irritability
  • aggressiveness, impulsivity, uncontrollable outbursts
  • racing thoughts and speech
  • exaggerated sense of optimism and self-confidence
  • grandiose thinking

Here’s one person’s account of a bipolar manic episode.

In severe cases, hallucinations and delusions (psychosis) can happen.

Symptoms of hypomania are the same, but less intense and without hallucinations or delusions.

Symptoms of depressive episodes

Signs and symptoms of a depressive episode can include:

  • persistent sadness
  • crying spells
  • pessimism, indifference
  • lack of energy, fatigue
  • sleeping too much or inability to sleep at all
  • unexplained aches and pains
  • irritability, anxiety, agitation, anger
  • feeling worthless, hopeless, or guilty
  • lack of concentration, forgetfulness
  • loss interest in things you once enjoyed
  • withdrawal from social situations
  • alcohol or other substance abuse
  • thoughts of death, self-harm, or suicide

Five or more symptoms must be present during the same two-week period and represent a change from previous functioning; at least one of the symptoms must be either a depressed mood or loss of interest or pleasure.

Experts aren’t sure what causes bipolar disorder or rapid cycling. Among people with bipolar disorder, about 12 to 24 percent develop rapid cycling at some point.

Anyone with bipolar disorder can develop rapid cycling. It may occur more in women than men, but this still isn’t completely clear.

It may also be associated with:

  • severe bipolar 1
  • thyroid issues
  • taking certain antidepressants
  • a history of substance use disorder

It may also be related to an earlier age at onset and longer course of illness.

Rapid cycling can take some time to diagnose because it requires having at least four episodes over the course of the year. Part of the diagnostic criteria also involves having at least two months between episodes.

The symptoms of rapid cycling can be hard to recognize, especially if someone tends to spend more time in a depressive state. As a result, rapid cycling may be underdiagnosed or reported.

If you suspect you’re experiencing rapid cycling, try keeping track of:

  • your daily moods
  • medications
  • symptoms
  • life events and stressors
  • sleep patterns

You can do this in a journal, app, or chart. The Center for Quality Assessment and Improvement in Mental Health has a detailed mood chart you can download here.

You can also check our list of the year’s best apps for people with bipolar disorder, including mood trackers.

Bring this information with you when you see your doctor for a diagnosis.

Bipolar disorder, including rapid cycling bipolar disorder, is treatable with medication. But it may take some time to find the right one.

Your doctor will work with you to find the right medication or combination of medications to manage your symptoms. During this time, they might make occasional adjustments to your dosage and treatment plan.

Some types of medication used to treat rapid cycling bipolar disorder include:

  • mood stabilizers
  • antidepressants
  • atypical antipsychotics

Any antidepressants you already take may need to be adjusted or discontinued. It may also take more than one medication to get symptoms under control.

While the mood stabilizer lithium is often used to treat bipolar disorder, it may not be helpful for people experiencing rapid cycling. Valproic acid, an anti-convulsant, may be more effective for rapid cycling.

It’s important to carefully follow instructions regarding these medications. Stopping them or altering the dosage without consulting your doctor can have serious unintended side effects.

Other treatments that may help include:

While these treatments can help, your doctor will likely still recommend taking medication as well. Using medication to manage your symptoms while trying these treatments can make it easier to fully participate and reap their potential benefits.

Rapid cycling bipolar disorder is a serious condition that can increase the likelihood of suicide. That’s why it’s so important to follow your treatment plan and keep your doctor informed about your symptoms and state of mind.

If you can’t afford treatment, the Anxiety and Depression Association of America offers resources for finding low-cost therapy and prescription medication.

It may also be helpful to find an online or in-person support group to connect with others facing similar issues. The Depression and Bipolar Support Alliance allows you to search for groups in your area and join online groups as well.

Other things that can help include:

  • avoiding alcohol and drugs that haven’t been prescribed by your physician, as these can make matters worse
  • confiding in a close friend or family member when you feel like you may be acting recklessly or putting yourself in danger
  • maintaining daily routines, such as getting up and going to bed at the same time
  • telling those you trust and feel close to about symptoms to watch for that may indicate you’re heading toward an episode
  • reaching out to a doctor as soon as you feel your symptoms worsening

Suicide prevention

  1. If you think someone is at immediate risk of self-harm or hurting another person:
  2. • Call 911 or your local emergency number.
  3. • Stay with the person until help arrives.
  4. • Remove any guns, knives, medications, or other things that may cause harm.
  5. • Listen, but don’t judge, argue, threaten, or yell.
  6. If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.
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If someone you care about has rapid cycling bipolar disorder, there are a few things you can do to support them. When offering help, try not to appear judgmental, even if something they’ve done bothers you or rubs you the wrong way. Chances are, their behavior is a symptom of their condition, not anything personal against you.

Other tips include:

  • keeping a list of their medications and doctors handy in case of an emergency
  • offering help when you spot early warning signs of mania or depression
  • remaining calm if they become angry or argumentative
  • calling emergency services if they seem to be in a dangerous situation

Above all, try to be an open ear to their feelings and concerns. Living with mental illness can be isolating for many people. Sometimes, giving someone space to just vent their frustrations can go a long way.