Bipolar disorder is a serious condition, resulting in periods of manic and depressive episodes. Bipolar disorder typically begins in the late teen years and affects more than two and a half million Americans, according to the Depression and Bipolar Support Alliance. Bipolar patients' mood state--manic or depressive--typically lasts for weeks or months at a time; however, some patients experience a condition known as "rapid cycling" bipolar disorder, in which the mood changes occur more often and are typically very intense.
Characteristics
The Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, defines rapid cycling bipolar disorder as a form of bipolar in which four or more episodes of mania or major depression are experienced annually. The Depression and Bipolar Support Alliance reports that mood changes, from one extreme mood state to the other, can be sudden, rapid, and happen within a matter of days. In rare cases, mood shifts may occur within hours and be characterized by irritability, anger, impulsiveness and outbursts.
Causes
In some cases, there is no clear cause for rapid cycling, although certain risk factors are well known. Such risk factors include taking certain antidepressants, as well as stopping or changing a current medication for bipolar disorder. Women are more likely than men to develop rapid cycling. The Depression and Bipolar Support Alliance indicates that a history of substance abuse may make a person more likely to experience rapid cycling as well, though it is unknown if the substance abuse causes the rapid cycling, or if the rapid cycling causes a person to self-medicate with substances, which then lead to substance abuse.
Treatments
Treating rapid cycling bipolar disorder can be a challenge. Typically, these patients require medication, but patients may need to try several medications before discovering the most effective one. These patients usually try the same medications as other bipolar patients, some medications are more effective than others. The largest placebo-controlled study of rapid cycling bipolar disorder conducted by Calabrese et al. in 2005 showed that Lamictal is most effective to treat rapid cycling episodes. Lithium and Depakote are also often used by these patients, and may be used in conjunction with Lamictal.
It's also often helpful for patients to keep a record of their mood patterns and medications, which allows patients and doctors to track the progression of rapid cycling mood shifts, identify any patterns prior to a mood shift, and track progress made on medication.
Duration of Illness
Bipolar disorder is a lifelong illness with no cure. However, rapid cycling is typically short-lived and within two years, patients most often return to typical bipolar cycles. The longer a person goes without proper treatment, the longer her more frequent episodes might continue to occur. The Depression and Bipolar Support Alliance indicates a small number of individuals will continue rapid cycling indefinitely.
Prognosis
Dr. Coryell, a professor of psychiatry at the University of Iowa, published research in the Archives of General Psychiatry reporting that the long-term prognosis for patients with rapid cycling bipolar differs from that of other bipolar patients. Dr. Coryell conducted a long-term study of 345 patients with bipolar disorder and followed the patients for a mean of 13.7 years. Dr. Coryell and associates found that patients with rapid cycling are at an increased risk for suicide attempts and were more likely to have serious depression symptoms in any given week, compared with bipolar patients without rapid cycling.
References
- Treatment Considerations for Patients Experiencing Rapid-Cycling Bipolar Disorder
- Department of Psychiatry & Behavioural Sciences: Rapid cycling bipolar disorder.
- Depression and Bipolar Support Alliance: Rapid Cycling and its Treatment
- What are the long term effects of rapid cycling bipolar disorder
