Bipolar disorder: What is rapid cycling?
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, 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, or depressive episodes in a 12-month period, this is called rapid cycling.
Causes of rapid cycling
There is no clear trigger for rapid cycling, but bipolar changes occur due to changes in brain chemicals. Doctors and scientists have proposed a number of reasons why this might happen.
One theory is that changes in circadian rhythms underlie rapid cycling.
Some research has suggested that circadian rhythm regulation may have an impact, as sleep disturbances occur alongside mood changes.
In 2018, one researcher found correlations between the sleep patterns of 18 men with rapid-cycling bipolar disorder and the moon's tides, suggesting that this might have an influence.
The investigator suggested that, in rapid-cycling, a part of the body's "circadian pacemaker" may have become "uncoupled" from the day's normal 24-hour rhythm.
This supports the findings 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.
One psychiatrist, Dr. S. Nassir Ghaemi, has written about his professional observations of rapid cycling bipolar disorder for The American Journal of Psychiatry.
Dr. Ghaemi recommended avoiding any type of medication that can destabilize a person's mood.
Other health conditions
Other possible triggers for rapid cycling in people who are susceptible to bipolar disorder might be:
- certain neurological conditions, such as multiple sclerosis
- developmental delay
- a head injury
Sensitization to stress
Another possible cause of rapid cycling is known as kindling, or sensitization.
This theory says that initial episodes happen when actual or expected life events cause stress.
The person becomes increasingly sensitive to things that may trigger the cycles, and they become more likely to follow this pattern over time.
Without treatment, bipolar disorder and episodes of stress can result in rapid cycling.
Who has rapid cycling?
Anyone with bipolar disorder can experience rapid cycling, but it is more likely to affect women than men.
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 year.
A study published in 2014 in the Journal of Clinical Psychiatry also suggests that rapid cycling might be more likely to affect those who:
- have had bipolar symptoms for a longer period of time
- were relatively young when bipolar symptoms first appeared
- are more prone to substance and alcohol abuse
- have a higher risk of suicide
This does not mean that these factors cause rapid cycling, only that they are more likely to occur with this type of disorder.
What do mood swings look like?
Rapid cycling involves extreme changes in moods four or more times in a 12-month period.
These changes can be mentally and physically exhausting.
Licensed therapist Harold Jonas explains that rapid-cycling bipolar disorder:
"Makes a person literally live life at its extreme ranges of emotion and pushes their mental and physical endurance to the brink. It's a literal rollercoaster where the emotional 'highs' are very high, and the 'lows' are dangerously low."
The following symptoms can occur when a person has rapid-cycling bipolar disorder.
Rapid-cycling manic episode
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
- increased positivity and self-confidence
- increased irritability and aggression
- reduced need for sleep without tiring
- racing speech and thoughts
- overreaction to stimuli
- increased libido, or sex drive
- impulsiveness or poor judgment, which may lead to reckless behavior
- delusions and hallucinations, which may include a sense of self-importance
A hypomanic episode is similar to a manic episode but less severe and without the delusions or hallucinations that can occur in a manic episode).
It is different from a person's non-depressed mood. There is a clear change in activity and attitude and visible behavior that is out of character.
Rapid-cycling depressive episode
A major depressive episode can follow or precede a manic episode. To be considered a major depressive episode, the symptoms must last about 2 weeks or more.
During this time, five or more of the following symptoms are present:
- extreme sadness or unexplained crying spells
- changes in appetite and sleep patterns
- irritability, anger, worry, agitation, or anxiety
- pessimism or indifference
- exhaustion or loss of energy
- unexplained aches and pains
- feeling guilty, worthless, or hopeless
- excessive concern about failures and inadequacies
- reduced libido, or sex drive
- inability to concentrate, leading to indecisiveness
- inability to enjoy former interests, social withdrawal
- misuse of alcohol intake or other substances
- recurring thoughts of death or suicide
Mixed state or mixed mania
Some people may experience what is known as a "mixed state" when symptoms of a manic and depressive state are both present at the same time.
Dr. Jonas explained to MNT: "People who experience mixed states describe feeling activated and 'revved up,' but also full of anguish and despair."
He explained that, during mixed mania, a person may experience all of the following over the course of a few minutes:
- rapid, pressured speech
- impulsive, out-of-control thoughts of suicide, self-destruction or aggression
- uncontrollable swings between racing thoughts and a feeling of "being in blackness"
What do bipolar mood swings feel like?
For those who are trying to help their loved ones cope with bipolar disorder, it is important to try and understand what the cycles 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.
Rachel Kallem Whitman, who received a diagnosis of bipolar disorder at the age of 17 years, described for MNT her experience of mania:
"My mania comes with feelings of grandiosity, invincibility, and delusions. In addition to my mania making me feel electric, seductive, and brilliant, during episodes I also feel like I'm touched by God and consider Princess Diana to be my guardian angel, which is interesting because I'm a devout atheist."
As with other types of bipolar disorder, treatment is available.
Counseling can help a person to manage bipolar disorder.
- medications to stabilize mood and, if necessary, to prevent psychosis
- anti-depressant drugs, if determined appropriate
- joining a support group or network
It can take time to find the right drugs in the right amounts to suit an individual's needs. It is important not to change the dose or stop taking a medication without speaking to a doctor first.
Sometimes people with bipolar disorder stop using their medication because of the side effects or because, when they feel good, they believe they do not need it.
It may also help to keep a track of moods. If a pattern appears, this may enable the person to be prepared for the next change and perhaps to avoid or minimize certain triggers.
Rapid cycling is a form of bipolar disorder in which mood changes can happen several times throughout the year.
This can be confusing and frightening for both the person who experiences it and for their loved ones.
Treatment is available, but it can take time to reach a diagnosis of any type of bipolar disorder and also to find the right balance of treatment.
Anyone who has a friend or relative with rapid-cycling bipolar disorder can help the person by learning as much as they can about the condition and offering support as the person goes through their mood changes or treatment plan.