Rapid Cycling
According to the DSM-IV, the essential feature of rapid cycling bipolar disorder is the occurrence of four or more mood episodes during the previous 12 months. These episodes can occur in any combination and order. However, the episodes of Major Depression, Manic, Mixed or hypomanic episodes must be separated by a period of full remission or by a switch to an episode of the opposite polarity.
Rapid Cycling occurs in approximately 10%-20% of individuals with bipolar disorders. Whereas in bipolar disorder in general the sex ratio is equal, women comprise 70%-90% of individuals with a rapid-cycling pattern. The mood episodes are not linked to any phase of the menstrual cycle and occur in both pre- and postmenopausal women. Rapid cycling may be associated with hypothyroidism, certain neurological conditions (e.g. multiple sclerosis), developmental delay or head injury. Rapid cycling can occur at any time during the course of bipolar disorder especially after the use of tricyclic antidepressant drugs and may appear and disappear.
Treatment
It can be challenging to find an effective treatment for rapid cycling. The lithium response rate for those with rapid cycling is only 20-40%. Anticonvulsant medications (such as valproic acid) have been effective in the treatment of lithium resistant rapid cycling and mixed states. Anti-psychotic medications can also be helpful in treating people with rapid cycling bipolar disorder. Talk to your doctor about your individual treatment plan.
Antidepressant medications, particularly tricyclics, may provoke rapid cycling. Psychotropic medications should be tapered off gradually under the supervision of your doctor.
Psychosocial Considerations
Rapid cycling can often lead to turbulent behaviour and disturbed relationships. People experience rapid cycling in varying patterns. Each individual can observe themselves for signs that signal the approach of their episodes, depression or hypomania/mania. This is empowering and the knowledge gained decreases feelings of helplessness and hopelessness, which often occur in depression. Prompt action taken to reduce stimuli and irritability may also decrease the severity of the episode. Sometimes, it is difficult to be completely objective about how you are doing. Input from those people who know you well can be helpful. Your friends and family can give support and notify your psychiatrist when you are having difficulty.
Personal Strategies
- Prepare yourself for episodes of illness by learning about rapid cycling
- Discuss difficulties and successes with peers in support groups. You
are not alone.
- Sleep and rest are important. It is important to stabilize sleep,
reduce or stop the use of caffeine, nicotine, alcohol and substances.
Establish a bedtime routine. Rest when tired.
- Use relaxation techniques, affirmations and spiritual material
- Tell yourself frequently when distressed that change is inevitable
in rapid cycling. You got through episodes in the past and are able
to do it again.
- Don't pressure yourself with criticism and unrealistic expectations.
- Stay away from overstimulating situations. Keep your life simple and
ask for assistance if you need it.
- Stay in touch with family, friends and community support.
References
CANMAT, Bipolar Disorder: A Summary of Clinical Issues and Treatment Options (CANMAT Bipolar Disorder Sub-Committee, 1997) http://www.canmat.org/psychs/index.html
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) , fourth edition, American Psychiatric Association, 2000.
Websites for Rapid Cycling
Rapid Cycling from the Depressive and Bipolar Support
Alliance
www.dbsalliance.org/pdfs/rapidcycling.pdf
Circadian Rhythms Factor in Rapid- Cycling Bipolar Disorder
http://www.psychiatrictimes.com/p960533.html
Rapid Cycling by Colleen Sullivan
www.suite101.com/print_article.cfm/1073/23220
For further information and bibliographies see "Rapid cycling: a reference" in the Paul Horner Memorial Resource Library at the Mood Disorders Association of Ontario.