Bipolar disorder (also known as manic depression) is a treatable illness marked by extreme changes in mood, thought, energy and behavior. It is not a character flaw or a sign of personal weakness. Bipolar disorder is also known as manic depression because a person’s mood can alternate between the “poles” of mania (highs) and depression (lows). These changes in mood, or “mood swings,” can last for hours, days, weeks or months.
Nearly six (6) million adult Americans are affected by bipolar disorder. It usually begins in late adolescence (often appearing as depression during the teen years), although it can start in early childhood or later in life. An equal number of men and women develop this illness (men tend to begin with a manic episode, women with a depressive episode), and it is found among all ages, races, ethnic groups, and social classes. The illness tends to run in families and appears to have a genetic link. Like depression and other serious illnesses, bipolar disorder can also negatively affect spouses and partners, family members, friends, and coworkers.
Bipolar disorder differs significantly from clinical depression, although the symptoms for the depressive phase of the illness are similar. Most people who have bipolar disorder talk about experiencing “highs” and “lows”—periods of mania and depression. These swings can be severe, ranging from extreme energy to deep despair. The severity of the mood swings and the way they disrupt normal life activities distinguish bipolar mood episodes from ordinary mood changes.
When people experience symptoms of both a manic and a depressive episode at the same time, they’re said to be experiencing a mixed state (or mixed mania). They have all of the negative feelings that come with depression, but they also feel agitated, restless and activated, or “wired.” Those who have had a mixed state often describe it as the very worst part of bipolar disorder.
Symptoms of Mania: The “Highs” of Bipolar Disorder
Heightened mood, exaggerated optimism and self-confidence
Excessive irritability, aggressive behavior
Decreased need for sleep without experiencing fatigue
Grandiose thoughts, inflated sense of self-importance
Racing speech, racing thoughts, flight of ideas
Impulsiveness, poor judgment, easily distracted
In the most severe cases, delusions and hallucinations
Symptoms of Depression: The “Lows” of Bipolar Disorder
Prolonged sadness or unexplained crying spells
Significant changes in appetite and sleep patterns
Irritability, anger, worry, agitation, anxiety
Loss of energy, persistent lethargy
Feelings of guilt, worthlessness
Inability to concentrate, indecisiveness
Inability to take pleasure in former interests, social withdrawal
Unexplained aches and pains
Recurring thoughts of death or suicide
As you can see from the list above, the symptoms of bipolar disorder’s “low” period are very similar to those of unipolar depression. That’s why the “lows” of this illness are sometimes referred to as “bipolar depression.” These lows are one thing that most mood disorders have in common.
People with bipolar disorder experience bipolar depression (the lows) more often than mania or hypomania (the highs). Bipolar depression is also more likely to be accompanied by disability and suicidal thinking and behavior.
It’s during periods of bipolar depression that most people get professional help and receive a diagnosis. In fact, most people with bipolar disorder in the outpatient setting are initially seen for—and diagnosed with—unipolar depression.
Studies show that, in the primary care setting alone, 10-25 percent of those diagnosed with unipolar depression may actually have bipolar disorder. And the percentage is even higher in the psychiatric setting. And incorrect treatment for bipolar disorder can actually lead to episodes of mania and other problems. Learn more about bipolar depression in our brochure, Mood Disorders and Different Kinds of Depression.
Types of Bipolar Disorder
Patterns and severity of symptoms (or episodes of “highs” and “lows”) determine different types of bipolar disorder. The two most common types are bipolar I disorder and bipolar II disorder. More on Types of Bipolar Disorder Treatments
Treatment of bipolar disorder may include support groups, medication, talk therapy, or other strategies that you and your health care provider may want to try. The right treatment is the one that works best for you. More on Treatments
Bipolar Disorder across the Lifespan
Bipolar disorder can affect anyone, including children, adolescents, adults, and the elderly.
Rapid cycling bipolar disorder can be a dangerous condition and carries a high risk of suicide. When a person with bipolar experiences four or more manic, hypomanic, or depressive episodes in any 12-month period, it’s defined as rapid cycling bipolar. While the term rapid cycling may make it sound as if the episodes occur in regular cycles, episodes actually often follow a random pattern. Because of the rapid mood swings associated with this type of bipolar disorder, the individual may feel as if they’re on an emotional roller coaster; swinging from the highs of mania to the depths of depression — all in the course of a few days or even hours.
Any type of bipolar disorder can be rapid cycling. It is thought between 10% -20% of people with bipolar disorder rapid cycle.2
Understanding Rapid Cycling Bipolar Disorder
Bipolar disorder is characterized by episodes of depression and either mania or hypomania, as in the case of bipolar type 2. According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), episodes must last a minimum length of time:
- Four days for hypomania
- One week for mania
- Two weeks for depression
While those are minimum lengths of time, many people with bipolar disorder spend more, sometimes considerably more time in an episode. On average, people have between 0.4-0.7 episodes per year, lasting three to six months.1 Between episodes, there may be periods of normalcy (without an elevated or depressed mood). Rapid cycling bipolar disorder is the dramatic speeding up of these cycles.
Rapid Cycling Bipolar Disorder Symptoms and Effects
While the DSM-IV-TR only defines one type of rapid cycling, particularly short cycles are also known to occur. Ultra-rapid cycling denotes episodes only lasting days and ultradian indicates multiple episodes per day.
Rapid cycling bipolar disorder can be more difficult to detect than standard bipolar disorder as patients, particularly those with a short hypomanic cycle, may see the hypomania as simply a rare “good mood” rather than an actual mood episode. Since they spend more time depressed, they are often misdiagnosed with depression.
The hallmark symptoms of rapid cycling bipolar are mood and energy changes that are out-of control and disabling. The person may experience severe irritability, anger, impulsivity, and uncontrollable outbursts.
Treatment of Rapid Cycling Bipolar Disorder
People who experience rapid cycling bipolar are hospitalized more often and their symptoms are usually more difficult to control over the long term.
Rapid cycling is more common in people with type 2 bipolar disorder and people with bipolar 2 have been shown to spend 35 times more time depressed than hypomanic. Because of this, rapid cycling treatment tends to be focused around relieving the depression.
While antidepressants would seem to be the logical choice for treatment of a depressive episode, antidepressants can often make rapid cycling worse. Antidepressants for bipolar depression can induce cycling, create more rapid cycling or even induce a manic episode.
Mood stabilizers are the preferred treatment for rapid cycling bipolar disorder with the aim to stop the cycling and then bring the mood up, if needed. Common mood stabilizers used in the treatment of rapid cycling bipolar disorder include:3
- Anticonvulsants like valproic acid (Depakote) or Carbamazepine (Tegretol)
- Antipsychotics, normally newer generation antipsychotics likeQuetiapine (Seroquel) or Aripiprazole (Abilify)
Anticonvulsants are typically the first choice mood stabilizers as both valproic acid and carbamazepine have been shown effective in treating rapid cycling bipolar disorder. If an antidepressant is used, it is used in combination with a mood stabilizer to prevent further cycling. Antidepressants are typically tapered once the depression is under control.
- Bipolar Disorder – What to Say, What Not to Say (everydayhealth.com)
- History of Bipolar Disorder (doctorbipolar.me)
- Do You Understand the Bipolar Spectrum? (psychcentral.com)
- Bipolar Disorder in the Black Community (mechanicalanation.wordpress.com)