What Is Rapid Cycling Bipolar Disorder?

Approximately 2.8% of people in the United States live with bipolar disorder, a mental health disorder characterized by fluctuating moods and energy levels, including highs (manic episodes) and lows (depressive episodes). Individuals managing bipolar disorder may experience episodes of mania, hypomania, depression, or mixed states.

Rapid cycling is a specifier of bipolar disorder and characterized by frequent and distinct mood episodes that occur over a 12-month period. Moods can fluctuate over hours, days, or months. It can be present with any type (bipolar 1 or bipolar 2) of the condition.

Symptoms

Rapid cycling describes a characteristic of bipolar disorder in which a person cycles between at least four episodes in a 12-month period. Almost half of all people with bipolar disorder will experience rapid cycling at some point. It is usually temporary, but it can persist.

The symptoms a person may experience during rapid cycling bipolar disorder are the same that occur in mania or depression.

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the handbook used by mental health professionals to diagnose mental health conditions, mania is characterized by:

• Euphoria or heightened mood; or irritability
  
• Inflated sense of self, grandiose thoughts
  
• Racing thoughts
• Fast and excessive speech
• Distractibility
• Decreased need for sleep
• Increased goal-oriented activity (socially, at work, or sexually); or physical restlessness
• Impulsiveness and risky behaviors
• In severe cases, delusions and hallucinations 

The symptoms of hypomania mirror those described above. The difference between mania and hypomania is the intensity of symptoms. Hypomania is less severe than mania. Additionally, delusions and hallucinations typically do not occur with hypomania.

In bipolar disorder, depression can manifest in the following ways: 

• Emotions such as sadness, hopelessness, pessimism, and anxiety
• Significant changes in eating
• Changes in sleeping patterns
• Lack of energy or lethargy 
• Loss of interest in daily activities or that once brought pleasure
• Physical restlessness or slowed movement
• Feelings of worthlessness or excessive guilt
• Difficulty concentrating
• Thoughts about death or suicide (suicidal ideation) 
  

Causes

The cause of rapid cycling in bipolar disorder is unknown. However, research provides insight into factors that may play a role, including:

• Antidepressants: The use of antidepressants may trigger changes in mood and cause rapid cycling.
• Thyroid issues: An underactive thyroid may mean that the body is not producing the appropriate level of hormones. One study examining the link between thyroid disease and bipolar disorder showed that thyroid problems can lead to significant changes in mood, such as depression or, in some cases, mania.
• Circadian rhythm: Changes in this natural biological process (the body's internal clock), which is responsible for regulating essential functions like heart rate and metabolism, can influence rapid cycling by impacting sleep. Lack of sleep can trigger and exacerbate (worsen) symptoms of bipolar disorder, while consistent and healthy sleeping habits can help mitigate symptoms.

A review of research on rapid cycling in bipolar disorder determined that it can shape the course of the condition. Rapid cycling may be linked to a longer course of debilitating symptoms and cycling, and an increase in suicidal thoughts and behaviors.

Diagnosis

Bipolar disorder is diagnosed using the DSM-5 criteria, the primary factor being at least one manic episode for bipolar 1 disorder, and a hypomanic episode for bipolar 2 disorder. This information is determined through an interview or examination.

A mental health professional may assign the specifier of rapid cycling when a patient experiences at least four distinct mood episodes in a 12-month period. A period of remission or switching to another state should occur between each episode to separate them.

For instance, a person may experience an episode of depression, followed by a period of mania, then another bout of depression, and another period of mania all in one year.

Upon determining that a person is experiencing rapid cycling in bipolar disorder, the patient and their healthcare provider can collaborate on a treatment plan to support the patient’s needs.

Risks

Frequent changes in mood can impact an individual’s daily functioning and their relationships with others. Eating and sleeping habits may suffer. Thoughts and emotions may seem unbalanced or chaotic. An individual may struggle to keep up with school or work while navigating symptoms during episodes.

A couple of risks associated with rapid cycling in bipolar disorder include:

• Psychosis: Repeated disturbances in mood may lead to psychosis. This can include delusions, hallucinations, and loss of contact with reality.
• Suicide: People living with bipolar disorder already have an increased risk of suicide. Individuals with rapid cycling grapple with suicidal thoughts throughout their lifetime and have a higher risk for attempting suicide.
  

Working with a medical or mental health professional can help determine a plan to mitigate risk in the best possible way.

Treatment

Treatment is essential for managing rapid cycling. A combination of medication and therapy can help with mood stabilization and provide a safe space for patients to discuss their symptoms.

Medication

Mood stabilizers such as lithium and lamotrigine (Lamictal) can help create equilibrium for patients.

Antipsychotic medications such as quetiapine (Seroquel) and olanzapine (Zyprexa) and the antidepressant fluoxetine (Prozac) may be prescribed to alleviate symptoms of psychosis, mania, and depression.

Everyone responds differently to medication, so symptoms should be monitored and evaluated regularly by a healthcare professional to find the best medication combination as symptoms change.

Therapy

Psychotherapy (talk therapy) fosters a safe environment for patients to talk about challenges they are facing living with bipolar disorder.

A therapist or mental health professional can help individuals learn to identify, track, and cope with symptoms. They can treat rapid cycling bipolar disorder by developing a plan of action the patient can rely on if their symptoms deteriorate or they find themselves in crisis.

A Word From Verywell

Living with bipolar disorder, especially with rapid cycling, can be challenging. Prioritizing your mental health will help you cope with episodes of rapid cycling. While symptoms can be scary, exhausting, and even debilitating, treatment is available.

Working with a care team that understands your needs can help you manage the course of the condition. Building a network of people you can trust and talk to can also support your well-being.