Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling occurs in 10-20% of all people with bipolar disorder, and is more common in women (read this article for more facts about rapid cycling).
Bipolar disorder varies greatly from person to person. Similarly, rapid cycling can also mean different things for different people. To meet the clinical definition, there must be 4 episodes in a year. But some individuals can experience multiple mood shifts in the same day (for a visual depiction of this, check out the graphs in this article). Rapid cycling can also vary in how consistent it is: some people see the same patterns year after year, and for others it seems to be random. In this article we will hear from 3 different perspectives:
- Melanie, who often experiences several cycles in the same day
- Lauren, who’s rapid cycling changes throughout the year
- Lyndsay, who consistently has around 4 mood shifts per year
What does rapid cycling feel like?
Melanie: For me, rapid cycling is when I experience multiple “highs” and “lows” in a day. I am an extreme rapid cycler and I have several mood shifts throughout the course of a day. It’s really hard to handle, and it’s exhausting, as someone who works full time in an office setting. It doesn’t change minute to minute, but it sure feels that way! It really affects my energy levels and how I interact or want to interact with other people.
Rapid cycling feels like your mind is playing tricks on you. You are sad one minute, hyper the next, giddy, and then back to sad, teary, and wanting to hide. It’s very confusing and it’s scary how fast your mood can change and change and change. You feel like your moods are changing so quickly and you don’t know when you will feel “right” again. It is one of the most frustrating parts of having bipolar disorder.
I have to say that I have had to become a very good actress and very good at suppressing my moods at work, and as a result, at the end of the work day, or on the weekend, the moods can be more severe. I become frustrated with how emotionally labile I am, and I feel terrible that I have anger outbursts, am agitated and rude when I am in a hypomanic state, or that I am “useless” and amotivated when in a depressed state, i.e. unable to cook, clean, empty the dishwasher, put things away etc.”
What is also confusing and frustrating about rapid cycling is that you can be anxious regardless of what state you are in. Or at least, that’s what happens to me.
Lauren: Rapid cycling feels like a large roller coaster- but one that is never ending, with highs and lows of unknown duration and height/depth, going around over and over again. The depression of knowing you’ll fall, and the happiness when you’re climbing up, the anxiety when you realize you’re going to start falling again any moment.
Lyndsay: It feels painful (mentally and physically), stressful, scary, and dramatic. Most people think mania is great, but it’s not. During my manic episode, I spend a lot, I can’t feel any emotions, I shut people out, I’m impulsive, and I’m mean. Then I cycle into a depression, and it’s a quick transition. It’s usually a mixed episode for a couple weeks (both manic and depressed), and turns into full-blown depression. That’s when I deal with the repercussions of the mania. I’ll have spent all my money and find myself in severe debt. My relationship will need mending. My physical health will deteriorate. Imagine experiencing the mania to depression (back to mania) four or more times a year. It’s exhausting. And it hurts. It hurts my brain and it hurts my body. I think the worst part is knowing that it’s going to happen. No matter how hard I try to treat it in advance, it always happens; and I never know the severity in advance.
How often do you “rapid cycle”? Do you have mania or depression more often? Has it changed over time?
Melanie: It depends on the day. I notice that on a typical work day, I start off in a hypomanic state, I am okay for a few hours, then I feel a wave of sadness after lunch, then I have trouble focusing for the rest of the day. By the time I leave work, I can be a little hyper, and my mood will change again. Sometimes I get so hyper by the end of the day that I have trouble sleeping.
I first noticed the rapid cycling a couple of months after my diagnosis. Initially, my “main” state was hypomania. After a couple of years, it changed to depression. I am not sure if this had to do with life circumstances and events or if it’s “normal” for this to change over time. I do notice that when I am under stress, my predominant state switches to “hypomania”, because in that state, you feel “invincible”.
My rapid cycling involves multiple cycles throughout a day. The day will end with whatever the predominant mood is. Under stress, I am very hyper and have difficulties sleeping, experience insomnia and of course, this is a dangerous cycle in and of itself!
I think my rapid cycling will change again and again, depending on what is going on with my life.
Lauren: My rapid cycling varies- in the summer I get longer but more frequent lows, and in the winter I get higher and more frequent highs. My cycles could change on a weekly or monthly basis. Sometimes I feel ahead of the game and my meds are on track, other times it’s a guessing game and I can’t keep up. I’ve had several major depressive episodes, which add even more frustrations to the mix. Because of this, I usually have to adjust my medications several times a year. The doctors I’ve seen said this might just be my new “normal”.
I was diagnosed with Bipolar type 1 over 13 years ago, when I was 18, but it wasn’t until a few years later they determined it was rapid cycling. It’s been suggested that I had child onset bipolar, but since they didn’t think that was possible at the time they just called it ADHD. So honestly, I don’t remember a time in my life when I was “normal”. I remember getting in trouble a lot growing up, and not being able to control my emotions, but also not really knowing what my emotions even were in the first place. I look back on it now and honestly remember it as living in a haze until I was diagnosed properly and started on the correct medications.
Lyndsay: My rapid cycling is generally four times a year with little episodes in between. I would explain my episodes throughout the year like this: Every spring (March/April), I cycle into a manic state. My doctors and I assume it’s because of the time change, plus spring is “happier” than winter. I experience this mania for about four months, until a depression cycle comes along in August. I’m curious if this could be related to the start of school, as life changes from fun and playful to busy and structured. I become stable in October and stay that way until January when I find myself in a depression. Mania hits again in March/April. It’s like clockwork.
As I’ve gotten older, I find myself having more manic episodes than depression. I live in Southern California, so the abundant sunshine helps A LOT with managing depression (plus my sun lamp). When I lived in Ohio, the winters would generally be a time of severe depression.
It seems that all people with bipolar would experience this, but they don’t. My brother, for example, has bipolar disorder and generally cycles once or twice a year (between hypomania and depression). The important thing to remember is that there are multiple types of bipolar disorder. My brother is generally depressed most the time; but he’ll have a few hypomanic episodes here and there (they do not last long). Plus, he’s never experienced full-blown mania.
Do you have any tips on how to cope with rapid cycling?
Melanie: I try my best to avoid triggers like negative people, too much sugar, anxiety-provoking situations and too much stress. And don’t watch the news before bed!
It is hard to avoid stress, especially family emergencies and there is always “the unexpected”. You have to figure out what calms you down. I highly recommend meditation or hypnosis (hypnotherapy- it’s not what you think it is- not how it is portrayed on TV!). I have learned many techniques to calm down, even if it is short-lived from hypnosis. One technique that I tell people to try is counting backwards from 25, and picturing yourself writing each number down on a blackboard, one at a time, and erasing each number before writing the next. Visualization exercises help. And don’t forget to breathe. Another good one is counting backwards from 25 and picture yourself walking down a staircase, one step at a time. And each time you write down a number or walk down a step, take a deep breath!
Breathing is important. It is very scary when your heart is racing and you feel nauseous from anxiety, because you feel like you can’t breathe. I think if you can stay calm, maybe your moods won’t change as often, or you can make it slightly more bearable for yourself. I also recommend finding a hobby, or a distraction. Distracting your mind is very important. Recently, I bought adult “colouring books” and have been enjoying colouring in them and find it relaxing. Journaling or blogging is another great outlet- writing your feelings feels like I am getting the thoughts out of my system.
Lauren: Some people keep a log, but that can be difficult if you have a lot of cycling, so I get help from family and friends. My spouse has bipolar as well, and is able to clue me in on different changes so we can tackle them head-on. I also try not to get upset with myself if I get into a depression funk. I have little notes around my bed so when I wake up I can see them and remind myself that it’s not permanent. Sometimes the switch in cycles is so quick, I wake up feeling a complete 180 from the day before. I’m not going to lie, some days it’s really hard to be a functioning human, but somehow I always come out ok.
Lyndsay: Visit your doctors every single month, no matter what. I used to think I only needed to see my therapist and psychiatrist when I was depressed or needed medication. Boy, was I wrong. Seeing my therapist regularly meant she could see my cycling before I could. This happened multiple times. It’s important to have someone who is unbiased (and truly, just someone else) to tell you when things are changing. We don’t always recognize it until it’s too late. By seeing your doctors regularly, together, you can catch an episode before it happens. This usually results in tweaking medication or seeing your therapist more often. That may sound awful to some, but it will help you get through the episode/cycle with minimal effects (to yourself and your loved ones).
Also, keep a mood journal. I never realized how “scheduled” my episodes were until I started keeping a journal. It was only then that I knew when I would become manic or depressed, which helped me to plan/prepare in advance. It’s made such a difference.
As for coping, don’t shut people out. I used to do that, and it only made things worse. I had to learn how to let people in, and it took me a while (by a while, I mean years). It’s much easier to handle the episodes with someone stable around you. For example, during a manic episode, my boyfriend will monitor my spending and take away my credit cards (not forcefully; we made this agreement before the episode). When I am depressed, he will be calm and understanding, and know to get me ice cream when I need it. It helps tremendously to have someone who understands the best they can, and that only comes from allowing them to come into your life completely.
What do you wish other people knew about rapid cycling?
Melanie: I wish people knew how exhausting it is. It really is like being at war with yourself. You are fighting with your mind. You want to find a neutral state, but it’s very difficult when your moods keep shifting, shifting, shifting. It’s very hard to find “a happy medium” and to find calm when your mind is always in flux.
Rapid cycling is frustrating, and can seem scary and confusing to the person who experiences it and the people around him/her. The best way to help someone who experiences rapid cycling is to just be there! Be there by offering a hug, being patient, learning about it and lending an ear. Anyone who wants to support me, has to be willing to 1. Educate themselves and 2. Listen.
Lauren: I wish there was a way to read it better, not just for other people but for myself as well. Sometimes people don’t get it, they will remember I was depressed/upset, and then if I am suddenly happy, but then get down again, they just give up and get frustrated that they can’t read me or track how I am. It’s not like there is a countdown timer going for each cycle. If it’s frustrating for them, how do they think I feel?
Lyndsay: I wish other people knew that rapid cycling is a part of bipolar disorder, and I don’t need pity. That might sound harsh, and I don’t mean it to be. I don’t want people walking on eggshells around me, no matter the episode I’m in. I’m not “crazy” and I will be okay; it’s simply a part of my life. If I had an employer, I would hope they would somewhat understand that I will cycle frequently, and I’ll either need time off or need accommodations. Though I suppose that’s the reason I am self-employed. I’ve gotten used to the idea that “other people” won’t understand bipolar disorder or what I go through; but I don’t expect them to. I used to get really upset at people’s ignorance, but you’ve got to understand that they don’t experience what we do, so how would they know? And that it’s okay for them not to know. As long as they try to understand, that’s enough for me.