Rapid-Cycling Bipolar Disorder Symptoms, Risks, and Treatment

Table of ContentsView AllTable of ContentsCharacteristicsRisk FactorsImpact on Quality of LifeTreatment Options

Table of ContentsView All

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Table of Contents

Characteristics

Risk Factors

Impact on Quality of Life

Treatment Options

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Some people withbipolar disorderwill alternate between manic and depressive episodes once or twice a year. Others may only experience this once every few years. However, a small subset of people will have rapid cycling, in which the mood swings come fast and frequently.

Rapid cycling is considered one of the more severe form of bipolar disorder. The condition can seriously impair ability to function as well as quality of life.

Characteristics of Rapid Cycling Bipolar Disorder

In rapid-cycling bipolar disorder, mood swings may be random and unpredictable. There is usually no set pattern as to when an episode might occur and what form it may take. In some cases, the episodes may cycle every few months; in others, the cycling may occur monthly or weekly.

We don’t know why rapid cycling occurs and whether it will be an ongoing pattern or one that will eventually resolve. Rapid cycling may, in some cases, be a precursor to more severe manifestations of the disease, includingpsychosis.

Risk Factors for Rapid Cycling

Some estimates are that between 5% to 10% of people with bipolar disorder will meet the diagnostic criteria for rapid cycling.While scientists have yet to pinpoint the cause of the condition, they have identified a number of common risk factors.

Some studies have also suggested that the long-term use of antidepressants may contribute.This may explain, in part, why people diagnosed in their teens are at greater risk, given that they are more likely to be exposed to antidepressants for many years. Other research suggests that low thyroid function play a part, given that rapid cyclers are far more likely to be diagnosed with hypothyroidism.

Rapid-cycling bipolar disorder not only places individuals at greater risk of alcohol and substance abuse, but it also increases the likelihood of suicide and self-harm. A 2009 study from the University of Barcelona concluded that, as an independent risk factor, rapid cycling was associated with a nearly two-fold increase in the number of suicide attempts compared to non-rapid cyclers.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

Rapid cycling will almost certainly undermine quality of life. Most affected will be unable to maintain or commit to a set schedule, given the high variability of their mood state. Their job performance will typically suffer, and they may end up being hard to rely on, professionally or personally. Unless there are some means to curtail the mood swings, a rapid cycler will usually find it difficult to get or keep a job.

Almost without exception, rapid-cycling bipolar disorder is more difficult to treat than non-rapid-cycling bipolar disorder. But certain medications may be helpful.

Antidepressantssuch as Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline) have proven ineffective in breaking the cycle. These drugs may actually increase the speed at which cycles occur.

Mood stabilizershave proven far more effective, particularly if they are used in combination with anantipsychoticto manage symptoms of mania/hypomania. Lithium is a first-line treatment. Depakote (valproate), Lamictal (lamotrigine), or Tegretol (carbamazepine) are other options. Mood stabilizers may be prescribed indefinitely to prevent future episodes.

To support therapy, atypical antipsychotics such as Seroquel (quetiapine) or Zyprexa (olanzapine) may be used. If antidepressants have been used, they would be stopped as soon as the depressive episode is resolved.

A Word From Verywell

If you are being treated for rapid-cycling bipolar disorder, it is important to be patient and take it one step at a time. Finding the right combination of drugs can be a process of trial and error, and it may take several attempts before your doctor finds the combination that’s right for you.

Moreover, once treatment is started, it may take some time before you begin to feel the full benefits of therapy. To this end, it is important to seek support, attend support groups, and to continue working witha therapistuntil you are able to gain better control over your mood swings.

4 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Carvalho A, Dimellis D, Gonda X, et al.Rapid cycling in bipolar disorder: a systematic review.J Clin Psych.2014;75(6):e578-86. doi:10.4088/JCP.13r08905El-Mallakh RS, Vohringer PA, Ostacher MM, et al.Antidepressants worsen rapid-cycling course in bipolar disorder: A STEP-BD randomized clinical trial.J Affect Disord. 2016;190:895. doi:10.1016/j.jad.2015.04.054Chakrabarti S.Thyroid functions and bipolar affective disorder.J Thyroid Res.2011;2011:306367. doi:10.4061/2011/306367Garcia-Amador M. Colom M, Valenti F, et al.Suicide risk in rapid cycling bipolar patients.J Affect Disord. 2009;117(1-2):74-8. doi:10.1016/j.jad.2008.12/005

4 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Carvalho A, Dimellis D, Gonda X, et al.Rapid cycling in bipolar disorder: a systematic review.J Clin Psych.2014;75(6):e578-86. doi:10.4088/JCP.13r08905El-Mallakh RS, Vohringer PA, Ostacher MM, et al.Antidepressants worsen rapid-cycling course in bipolar disorder: A STEP-BD randomized clinical trial.J Affect Disord. 2016;190:895. doi:10.1016/j.jad.2015.04.054Chakrabarti S.Thyroid functions and bipolar affective disorder.J Thyroid Res.2011;2011:306367. doi:10.4061/2011/306367Garcia-Amador M. Colom M, Valenti F, et al.Suicide risk in rapid cycling bipolar patients.J Affect Disord. 2009;117(1-2):74-8. doi:10.1016/j.jad.2008.12/005

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Carvalho A, Dimellis D, Gonda X, et al.Rapid cycling in bipolar disorder: a systematic review.J Clin Psych.2014;75(6):e578-86. doi:10.4088/JCP.13r08905El-Mallakh RS, Vohringer PA, Ostacher MM, et al.Antidepressants worsen rapid-cycling course in bipolar disorder: A STEP-BD randomized clinical trial.J Affect Disord. 2016;190:895. doi:10.1016/j.jad.2015.04.054Chakrabarti S.Thyroid functions and bipolar affective disorder.J Thyroid Res.2011;2011:306367. doi:10.4061/2011/306367Garcia-Amador M. Colom M, Valenti F, et al.Suicide risk in rapid cycling bipolar patients.J Affect Disord. 2009;117(1-2):74-8. doi:10.1016/j.jad.2008.12/005

Carvalho A, Dimellis D, Gonda X, et al.Rapid cycling in bipolar disorder: a systematic review.J Clin Psych.2014;75(6):e578-86. doi:10.4088/JCP.13r08905

El-Mallakh RS, Vohringer PA, Ostacher MM, et al.Antidepressants worsen rapid-cycling course in bipolar disorder: A STEP-BD randomized clinical trial.J Affect Disord. 2016;190:895. doi:10.1016/j.jad.2015.04.054

Chakrabarti S.Thyroid functions and bipolar affective disorder.J Thyroid Res.2011;2011:306367. doi:10.4061/2011/306367

Garcia-Amador M. Colom M, Valenti F, et al.Suicide risk in rapid cycling bipolar patients.J Affect Disord. 2009;117(1-2):74-8. doi:10.1016/j.jad.2008.12/005

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