Rapid Cycling Bipolar

I have seen many ppl that dont understanding the meaning of rapid cycling. These are not changes that occur from hour to hour of day to day. They actually are much much slower. Episodes last 3-6 months. At least 4 major depressive, manic, hypomanic, or mixed episodes are required to have occurred during a 12 month period. I learned this from my PDoc and was surprised it was so infrequent. Just wanted to put that out there as I was under the impression that the changes could happen multiple time per day.

Bricky,

This is a good topic. From what I understand from my pdoc and therapist, what you have listed as criteria is the DSM definition. But, in actuality, the cycling can and does happen more rapidly over the course of a few hours, days, or weeks. Maybe one day the DSM will be updated to reflect this as it does happen and has happened to me and others I've read about and talked to. Just a thought.

Take good care,
Alice

My thinking is that there are both micro mood changes that happen on an hour to hour, day by day basis and there are macro mood changes that happen from weeks to months. During a hypomanic episode, for instance, someone may fluctuate between baseline and mania hour by hour or day by day, but the average mood is hypomanic which lasts weeks to months. Likewise with a depressive episode. One's mood might fluctuate between baseline and deep depression but on average it's where it's at as a depressive episode. And the average lasts weeks to months.

Exiled. wrote:My thinking is that there are both micro mood changes that happen on an hour to hour, day by day basis and there are macro mood changes that happen from weeks to months. During a hypomanic episode, for instance, someone may fluctuate between baseline and mania hour by hour or day by day, but the average mood is hypomanic which lasts weeks to months. Likewise with a depressive episode. One's mood might fluctuate between baseline and deep depression but on average it's where it's at as a depressive episode. And the average lasts weeks to months.

That makes a lot of sense, and somewhat reminds me of how my mood can fluctuate, but be mostly in the same state - either depression or hypomania. Thanks for that post. I just wish doctors would realize these types of fluctuations DO happen!

While that's the DSM definition of rapid cycling, bipolar is different for everyone, and as such there are many different versions of rapid cycling. Some have differentiated them by referring to them as ultra-rapid, ultraradian, etc. for the faster varieties (as in week to week, day to day type shifts). This doesn't make them illegitimate bipolar mood swings. While I've had the traditional months of depression, a week or so of mania type episodes, I've also had 3 days of SEVERE elevated mood, to the point of being unable to function AT ALL, followed by 3 days of SEVERE suicidal depressed mood, back to normal for a few days, and then repeated. My psychiatrist and I are in agreement that it's definitely still bipolar, though, even if I do have dozens of shifts per year sometimes (other times it's been more traditional); I also have a strong family history of bipolar, some of whom had the more DSM-friendly variety.

Maybe it's not how the DSM defines rapid cycling in its current incarnation, but the DSM changes, bipolar is probably best thought of as a spectrum, and I haven't met anyone in the psych field who thinks the DSM is spot-on about everything in the first place.

Lexicon_Devil wrote:I haven't met anyone in the psych field who thinks the DSM is spot-on about everything in the first place.

I have.

I'm curious what diagnosis (I, II, NOS) people have who experience (hour-to-hour) or (day-day-day) rapid shifts. It seems like Bipolar Disorder - NOS (296.8) is basically the diagnosis that is meant to account for this kind of "individually tailored" bipolar.

@ arbitrage, my psych is just calling it type 1 for now. When I'm up, I get paranoid delusions along with all the other fun crap, and sometimes mild hallucinations. That kind of disqualifies me for type 2, I guess, and while probably DSM-wise I might fit more into the NOS category, if it weren't for the swings usually being shorter I'd be clearly type 1 anyway.

Well maybe I need to find a new Pdoc since I discussed my 'ultra rapid cycling' w/ her and she said that I'm just very sensitive and emotional. She again said that bipolar doesnt cycle on an from hour to hour or even day to day. I have a difficult time agreeing. I believe I have hypomania episodes which for me just put me in a 'normal good mood'.....like 'normal' people It's also very difficult to tell if my meds are causing these mood changes or not. My original dx what depression and anxiety from 11 yrs ago. Much has changed since then. ie. Lots of changes and additions in meds....trying to find the right cocktail (extremely frustrating).

It really depends. If the moods are being triggered like emotional reactions, then I could see her having grounds to say that, but if they're not, then they're pretty obviously swings. Some pdocs are just old-fashioned and obsessive about current standards, just the same as some MDs in other specialties are. I'd recommend looking for someone who 1) recognizes the difference between rapid mood swings and emotional responses, 2) is up to date on the variations mood disorders can manifest as, and 3) doesn't insult you by saying you're "just" very sensitive and emotional. Even if that were the case, that wouldn't warrent dismissal of your concerns, and clearly would still require attention.

It could also be the medicine, or, if they're emotional responses, something like BPD (often mixed up with BP)? Which meds are you taking? It would probably be a good idea to at least seek a second opinion from someone more familiar with mood disorders (it seems like there is a common defecit in knowledge about these, even amongst doctors), maybe a third, and in the meantime try to see if your moods trace back to triggers or not (apart from general stress, which can certainly be a BP trigger).