Rapid-Cycling Cyclothymia

There are several types of bipolar disorder; all involve episodes of depression and mania to a degree.

Bipolar disorder is a lifelong illness. Episodes of mania and depression eventually can occur again if you don’t get treatment. Many people sometimes continue to have symptoms, even after getting treatment for their bipolar disorder. Here are the types of bipolar disorder:

  • Bipolar Idisorder involves periods of severe mood episodes from mania to depression.
  • Bipolar IIdisorder is a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression.
  • Cyclothymic disorder describes periods of hypomania with brief periods of depression that are not as extensive or long-lasting as seen in full depressive episodes.
  • Mixed features”refers to the occurrence of simultaneous symptoms of opposite mood polarities during manic, hypomanic or depressive episodes.  It’s marked by high energy, sleeplessness, and racing thoughts. At the same time, the person may feel hopeless, despairing, irritable, and suicidal.
  • Rapid-cycling is a term that describes having four or more mood episodes within a 12-month period. Episodes must last for some minimum number of days in order to be considered distinct episodes.  Some people also experience changes in polarity from high to low or vice-versa within a single week, or even within a single day — the full symptom profile that defines distinct, separate episodes may not be present (for example, the person may not have a decreased need for sleep), making such “ultra-rapid” cycling a more controversial phenomenon. Rapid cycling can occur at any time in the course of illness, although some researchers believe that it may be more common at later points in the lifetime duration of illness. Women appear more likely than men to have rapid cycling. A rapid-cycling pattern increases risk for severe depression and suicide attempts.Antidepressants may sometimes be associated with triggering or prolonging periods of rapid cycling. However, that theory is controversial and is still being studied.

 

Bipolar mania, hypomania, and depression are symptoms of bipolar disorder. The dramatic mood episodes of bipolar disorder do not follow a set pattern — depression does not always follow mania. A person may experience the same mood state several times — for weeks, months, even years at a time — before suddenly having the opposite mood. Also, the severity of mood phases can differ from person to person.

Hypomania is a less severe form of mania. Hypomania is a mood that many don’t perceive as a problem. It actually may feel pretty good. You have a greater sense of well-being and productivity. However, for someone with bipolar disorder, hypomania can evolve into mania — or can switch into serious depression.

The experience of these manic stages has been described this way:

Hypomania: At first when I’m high, it’s tremendous … ideas are fast … like shooting stars you follow until brighter ones appear… All shyness disappears, the right words and gestures are suddenly there … uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria … you can do anything … but somewhere this changes.

Mania: The fast ideas start coming too fast and there are far too many … overwhelming confusion replaces clarity … you stop keeping up with it … memory goes. Infectious humor ceases to amuse. Your friends become frightened … everything is now against the grain … you are irritable, angry, frightened, uncontrollable, and trapped.

If you have three or more of the mania symptoms below most of the day — nearly every day — for one week or longer, you may be having a manic episode of bipolar disorder:

  • Excessive happiness, hopefulness, and excitement
  • Sudden changes from being joyful to being irritable, angry, and hostile
  • Restlessness, increased energy, and less need for sleep
  • Rapid talk, talkativeness
  • Distractibility
  • Racing thoughts
  • High sex drive
  • Tendency to make grand and unattainable plans
  • Tendency to show poor judgment, such as impulsively deciding to quit a job
  • Inflated self-esteem or grandiosity — unrealistic beliefs in one’s ability, intelligence, and powers; may be delusional
  • Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions)

Some people with bipolar disorder become psychotic, hearing things that aren’t there. They may hold onto false beliefs, and cannot be swayed from them. In some instances, they see themselves as having superhuman skills and powers — even consider themselves to be god-like.

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