The condition affects about 60 million people worldwide. Although anyone can be diagnosed with bipolar disorder, it occurs most commonly in young adults. The average age of the bipolar disorder onset is 25, and it affects men and women equally.
Along with experiencing extreme changes in mood, people with bipolar disorder will also feel major changes in their energy levels and behaviors. These changes are referred to as cycles.
Someone with bipolar disorder generally experiences 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, it's called rapid cycling.
Contents of this article:
Causes of rapid cycling
There is no clear trigger for rapid cycling. Some research suggests abnormalities in circadian rhythm regulation might have an influence.
More recently, psychiatrist Dr. S. Nassir Ghaemi wrote about his professional observations for The American Journal of Psychiatry on another potential cause. Based on other research and his professional experience, Dr. Ghaemi suggests that antidepressants can increase the chances of rapid cycling bipolar disorder:
"Such patients often receive antidepressants for years, with or without mood stabilizers...Sometimes, in a minority of cases, usually with highly suicidal patients during depressive episodes, short-term antidepressant treatment may be warranted. But in most patients with rapid cycling, these mood destabilizers are best avoided."
Dr. S. Nassir Ghaemi
Studies suggest that antidepressants may increase rapid cycling.
One other potential cause of rapid cycling is known as kindling, or sensitization. This theory says that initial episodes are triggered by actual or expected life events that 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. Left untreated, bipolar disorder and these frequent episodes can result in rapid cycling.
Who is affected by rapid cycling?
Anyone with bipolar disorder can experience rapid cycling, but women do more often men. According to the Mood Disorders Association of Ontario, it occurs in about 10 to 20 percent of those diagnosed with bipolar disorder. That percentage increases to about 70 to 90 percent for women with bipolar.
A 2014 study also suggests that rapid cycling is related to those with:
- a longer course of illness
- an earlier age at onset
- more illegal drug and alcohol abuse
- an increased risk of committing suicide
Studies suggest rapid cycling may affect a much higher percentage of women than men.
For people diagnosed at an earlier age, bipolar disorder and rapid cycling can add to the sometimes stressful process of growing up. Misdiagnosis is relatively common with bipolar disorder patients, especially for those who are seen during a depressive state.
Rachel Kallem Whitman is a disability studies doctoral candidate who was diagnosed with bipolar disorder at 17. She told Medical News Today that it's important for patients and their loved ones to recognize and address the many complications that can add to a diagnosis.
"While I was diagnosed with bipolar disorder in my teens, I struggled with accepting my illness, taking care of myself, going to therapy, taking medication, and building my own relationship with my disorder until after college," she said.
"During college, I experienced my most significant episodes in part because I had minimal adult supervision and because college is the ideal environment for unchartered mania," she explained:
"Everywhere you go, you can engage in energizing discussions about topics you're passionate about with people whom you might not have ever met in your hometown, and this addictive energy and excitement is the best fuel for bipolar disorder - particularly mania."
Rachel Kallem Whitman
What do bipolar mood swings look like?
Someone who has rapid cycling will experience an extreme change in moods, going between a manic and a depressive state. As mentioned earlier, when this occurs four or more times in a 12-month period, it's called rapid cycling.
These changes are characteristic to bipolar mood swings, and they can be extremely mentally and physically exhausting.
"This illness 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," explained licensed therapist Harold Jonas.
He told MNT that people experiencing a bipolar mood swing might feel a loss of control and as though their mind is playing tricks on them:
"One moment they may be giddy, happy, and talkative and a few hours later they may be highly irritable, sensitive to sound, reclusive, and teary. It can be scary for the person who has rapid cycling - as well as those surrounding them."
Harold Jonas, Ph.D., LMHC, CAP
Dr. Jonas outlined the following symptoms to look for in a manic, hypomanic, and depressive state.
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:
- Raised physical and mental activity and energy
- Increased positivity and self-confidence
- Increased irritability and aggression
- Reduced need for sleep without tiring
- Excessive self-importance
- Racing speech and thoughts, which can lead to impulsiveness or poor judgment
- Reckless behavior
- Delusions and hallucinations
A hypomanic episode is similar to a manic episode but less severe and without delusions or hallucinations. 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.
Major depressive episode
A major depressive episode usually follows a manic episode and lasts about 2 weeks or more. During this time, five or more of the following symptoms are present:
People diagnosed with bipolar may experience extreme mood swings.
- Extended sadness or unexplained crying spells
- Big 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
- Inability to concentrate, leading to indecisiveness
- Inability to enjoy former interests, social withdrawal
- Excessive alcohol intake or use of chemical substances
- Recurring thoughts of death or suicide
Mixed state or mixed mania
During a mixed mania state, symptoms of a manic and depressive state are both present.
"People who experience mixed states describe feeling activated and 'revved up,' but also full of anguish and despair," added Dr. Jonas.
"Rapid, pressured speech can co-exist with impulsive, out-of-control thoughts of suicide and self-destruction or aggression. Hopelessness, irritability, uncontrollable swings between racing thoughts, and a feeling of 'being in blackness' can all happen over the course of minutes."
What do bipolar mood swings feel like?
For those trying to help their loved ones cope with bipolar disorder, it's important to try and understand what the cycles feel like.
On the outside, they may simply look like extreme highs and lows. For patients, however, they can also be paired with irrational thoughts and sensations.
"My mania comes with feelings of grandiosity, invincibility, and delusions," Whitman told MNT. "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."