Rapid cycling not on psych doc's radar? Is it new? Wtf?

Is rapid cycling a recent discovery or something? I'm having the weirdest time with my soon to be ex-therapist (have seen him 3 times now). One of the psychs at my university thought that I actually COULDN'T have bipolar because my moods don't always last at least two weeks at a time (they have in the past, but it's less frequent now). It runs in my family, I have the same issues as the others in my family who have it, and all the patterns and signs of progression are there (chronic depression was my first diagnosis, and more manic issues/episodes have been presenting since my early/mid teens); while I'm open to a different diagnosis, it seems pretty ridiculous to ignore all of this just because my swings *can* be shorter than two weeks.

For background, the past month I've been mood journaling, and the pattern right now seems to be 2-3 days way too far up (racing thoughts, insomnia, impulsive spending/behavior, rage, irritability, hyper-productive, and SUPER paranoid, often of things I don't even believe exist, esp at night), 2-3 days WAY too far down (suicidal, worthless, miserable, can't get out of bed or eat or talk), and then 2-4 days of being "normal" in a state of emotional hangover. Then repeat. This has been going on since September, and I was pretty normal for a couple months before that. I had issues in late spring, though, too, and mid-winter, so in that sense, it is the usual 3-5 times a year; it's just that each round is a whole bunch of cycling instead of just one mood swing.

Basically, my question is this: is rapid cycling something new, that older pdocs wouldn't know about? What's the deal? From what I've read, some bipolars have moods move from one to another within a single DAY. I've had depressions last months and (hypo?)manias last up to 9 days. My mood chart looks like a heartbeat readout and they're basically telling me that the only thing that'll help me is talk therapy, even though I'm having suicidal thoughts at least once a week (whether up or down). :/

From what I've read the DSM only allows for cycles for minimally 4 days, as well as only full on mixed state (full on combination of depression and mania).

Here's a pretty good (IMO) site on a more progressive view of these issues: http://www.psycheducation.org/depression/Waves.htm

I believe the actual definition for rapid cycling is 4 episodes in a year (in the UK) - so it is actually not that rapid. There is ultra rapid cycling too and I am not sure of the definition for that. In terms of whether psychs recognise it I am not sure how new a concept it is but I know that in the UK at least if ppl are cycling quickly they often consider BPD as well as BP - which does not seem very useful in those who are cycling rapidly. My psych knows about rapid cycling but she is quite young.

Cracked

Hmm. I know at least a couple users on here have really, REALLY rapid cycling (ultra or utlra radian), but the terminology seems fuzzy to me. As aforementioned, I only get into these periods of cycling a handful of times a year, but within each episode, there are sometimes a bunch of little swings, even if the pervading mood of the swing stays the same (in my present case, up since early September, with a pattern of up a few days, crashing a few days, baseline a few days, repeat).

I'm not ruling out BPD, either; I used to meet the criteria for it 90% of the time (at least, for a couple of years). Anymore, though, I almost never meet the minimum requirements for it to be a possibility. Plus, the idea of it seems weird to me when I do have totally normal, level months (1-3 at a time) here and there. But I'm also too close to the issue to judge.

When I went to the pdoc over a month ago my cycles lasted a few hours each. Now they're a few days each and that is not just improvement but simply relief -- at least I can make SOME of my appointments and SOME of my obligations. That alone makes side effects much more bearable.

Joe McManamy's book, "Living with bipolar and depression" mentions that DSM-IV defines rapid cycling as "four cycles per year, five days for mania/two weeks for depression", so according to DSM-IV my illness doesn't exist. Luckily my doctor thought outside the box. But if yours insists you can't possibly be have BP because cycles are too short, I suggest speaking to someone else.

LD,
Hi there. I agree with the posting above... I am rapid cycling (actually ultra-rapid, with mixed episodes on top of that), but if my pdoc looked in DSM-IV, I'd probably not fit the pattern.

I have found it useful to read up on non-scientific definitions on the internet. Now, I do remind myself that what I am reading is via internet, therefore, not etched in stone and possibly flawed. But I find searching for info online very helpful in "familiarizing" myself with topics and terms so that, if need be, I can investigate further via scientific sources I have available to me.

As far as the definition of "rapid cycling," I found a rather nice "lay definition" on a Bipolar information site... here's a snippet:

Question: What Is Rapid Cycling?

Answer: Rapid cycling, according to the American Psychiatric Association's Diagnostic and Statistical Manual, occurs when a person experiences four or more mood swings or episodes in a twelve-month period. An episode can consist of depression, mania, hypomania or even a mixed state. According to Mitzi Waltz in Bipolar Disorders, women and children are more likely to be rapid cyclers. Expert Consensus states that five to 15 percent of those with bipolar disorder fit the criteria for rapid cycling.

The term "ultra-rapid cycling" may be applied to those who cycle through episodes within a month or less. If this pattern occurs within a 24-hour period, the person's diagnosis could possibly be termed "ultra-ultra-rapid cycling" or "ultradian." It is often difficult to tell ultradian cycling from a mixed episode.
--------------------------------------

As far as whether rapid cycling is a new concept, I'm not sure when the concept was developed. I believe it may have either been when the diagnosis Manic-Depression was changed to Bipolar Disorder or during the more recent shift in the psychiatric community to labeling some disorders as being actually on a spectrum (levels of severity). In any case, it is not such a new concept that your providers wouldn't know what the heck it is. I, myself, prefer to have providers who are not elderly (ie- 60s and younger). I have seen very old providers and they, in my opinion, seem less open to the newer concepts and developments in psychiatry/psychology. I don't know the age of your provider, but if this person (or team) is not even aware of the concept of rapid cycling, I'd look into switching to (regardless of age) someone who knows what the heck rapid cycling is.

Hugs,
Kosh

Thanks for your replies! I'm definitely going to be looking for a new doc asap. The weird thing is, I have had 5+ days of mania, and well over 2 weeks of depression, it's just not how things manifest all the time. My psych has been pretty much ignoring me every time I say that, though, which is frustrating because I know the diagnostic criteria only requires ONE manic episode and a major depressive episode (the latter of which has taken up years of my life in the past). Ugh... Well, at least I know I'm not alone with my cycles being so fast. Time to go pdoc shopping.

I read the newly published revised Bipolar for Dummies book, and learned that now there is a bipolar NOS (not otherwise specified). It requires manic or depressive episodes that doctors can't categorize as unipolar depression. The episodes also can't fit into any of the other bipolar categories. IMO, if they are certain you aren't BP 1 or BP2 then call it BP NOS and start working on a solution.

Thanks, Nico; I actually ended up going to another psychiatrist, and she thinks it's BP 1 with rapid cycling and mixed states. It's just that my cycles are often shorter than usual, plus the other docs wanted to focus pretty much entirely on my childhood. Maybe it is NOS, but I have also had episodes that (less often these days for depression) match the standard mania and standard major depression, so who knows.

I supposed giving a specific diagnosis (BP1, BP2, BP NOS, etc) is required for a more accurate treatment plan, but I'm not sure how much a treatment plan would differ between those three. I'm newly diagnosed with BP1 so I'm still learning things. Luckily the new docs made a decision and I wish you the best.