What is Rapid Cycling?

Rapid cycling is defined in many manuals of psychiatry as four or more mood episodes in the same year for a patient with bipolar disorder. This is not a separate form of bipolar disorder, but rather a distinctive, symptomatic pattern that can come and go, depending on the patient. Some people with bipolar disorder never experience these mood episodes, others may regularly experience them, and some experience them intermittently. It can be challenging to treat patients while they are in a rapid cycling phase.

People with bipolar disorder can experience mania, an extremely elevated mood, and depression. In a mixed episode, both are experienced at the same time, but more commonly, patients transition between these two states and may also have periods of stability where they feel relatively neutral. This psychiatric disorder can be treated with medications like lithium, along with psychotherapy to help the patient address issues as they come up.

With rapid cycling, people have episodes of mania and depression more commonly than other patients with bipolar disorder. Some patients may cycle four or five times in a year, while others can experience much more rapid changes in their mood. In some cases, doctors use terms like “ultra-rapid cycling” and “ultra ultra-rapid cycling” to refer to patients who experience changes in a matter of days or within the same day. It is important to distinguish diagnostically between rapid cycling and mixed episodes in these cases.

For reasons not fully understood by psychiatric professionals, rapid cycling bipolar disorder tends to be more resistant to medication. If a patient was successfully using medication to manage the disorder, it may no longer be effective, and new medications may not work as well. Patients can try a variety of medications to see if there is a drug that will help them bring the rapid cycling under control, and psychotherapy can be used to explore possible triggers that might have acted as a catalyst to cause this condition in the patient.

For patients, these swings between mood episodes can be traumatic and frustrating. Family members, partners, and friends may also have difficulty surviving their loved ones' mood episodes, and adjusting as they work on managing their bipolar disorder. Patients and loved ones may find it helpful to meet in group therapy with a mental health professional who can provide advice and suggestions on helping loved ones with mood episodes. Group therapy with other bipolar patients can also be beneficial for some people.