FAQ: Rapid Cycling
Rapid cycling is a pattern of frequent, distinct episodes in Bipolar Disorder. In rapid cycling, a person with the disorder experiences 4 or more episodes of mania or depression in one year. It can occur at any point in the course of Bipolar Disorder, and can come and go over many years depending on how well the illness is treated; it is not necessarily a permanent or indefinite pattern of episodes.
Virtually anyone can develop Bipolar Disorder. About 2.5% of the U.S. population suffers from some form of Bipolar Disorder, nearly 6 million people. A rapid cycling pattern may occur in about 10% to 20% of people with the disorder. Women, and people with Bipolar 2 Disorder, are more likely to experience periods of rapid cycling. Most people are in their late teens or early 20s when symptoms of Bipolar Disorder first start. Nearly everyone with Bipolar Disorder develops it before age 50. People with an immediate family member with Bipolar Disorder are at higher risk.
Bipolar Disorder is diagnosed after someone experiences a hypomanic or manic episode along with multiple additional episodes of either mania, hypomania, or depression. Rapid cycling in itself is not a diagnosis, but rather a course specifier or descriptor of the course of illness. In Bipolar Disorder rapid cycling is identified when four or more distinct episodes of depression, mania, or hypomania occur during a one year period. Rapid cycling can occur at any time in the course of Bipolar Disorder and may come and go at varying points over a lifetime.
Bipolar Disorder can be difficult to identify since some episodes can simply wax and wane without resolving. As a result, they do not necessarily represent multiple separate and distinct episodes. Rapid cycling may seem to make the changing mood states of Bipolar Disorder more obvious, but because most people with rapid cycling Bipolar Disorder spend far more time depressed than manic or hypomanic, they are often misdiagnosed with unipolar depression. For example, in one study of people with Bipolar 2 Disorder, the amount of time spent depressed was more than 35 times the amount of time spent hypomanic. Also, people often don’t take note of their own hypomanic symptoms, mistaking them for a period of unusually good mood.
Because symptoms of depression dominate in most people with a rapid cycling course of Bipolar Disorder, treatment is usually aimed toward relieving depression while preventing the comings-and-goings of new episodes. Antidepressants’ such as Prozac, Paxil, and Zoloft have not been shown to treat the depression symptoms of rapid cycling Bipolar Disorder, and may even increase the frequency of new episodes over time. Many experts advise against Antidepressants such as Prozac, Paxil, and Zoloft to treat the depression symptoms of rapid cycling.
Often, a single mood stabilizer is ineffective at controlling episode recurrences, resulting in a need for combinations of mood stabilizers. Several antipsychotic medicines such as Zyprexa or Seroquel also have been studied in rapid cycling and are used as part of a treatment regimen, regardless of the presence or absence of psychosis (delusions and hallucinations). Treatment with mood stabilizers is usually continued even when a person is symptom-free. This helps prevent future episodes. Antidepressants, if and when used, are generally tapered as soon as depression is under control.
The most serious risk of a rapid cycling course in Bipolar Disorder is suicide. People with Bipolar Disorder are 10 times to 20 times more likely to commit suicide than people without Bipolar Disorder. Tragically, 8% to 20% of people with Bipolar Disorder eventually lose their lives to suicide. People with a rapid cycling course may be at even higher risk for suicide than those with non-rapid cycling Bipolar Disorder. They are hospitalized more often, and their symptoms are usually more difficult to control long term. Treatment reduces the likelihood of serious depression and suicide. Lithium in particular, taken long term, reduces the risk. People with bipolar disorder are also at higher risk for substance abuse. Nearly 60% of people with Bipolar Disorder abuse drugs or alcohol. Substance abuse is associated with more severe or poorly controlled Bipolar Disorder.