When major mood episodes in bipolar disorder happen multiple times in a month, sometimes switching from one polar opposite to the other within days, you may be experiencing ultra-rapid cycling bipolar disorder.
Bipolar disorder is a mental health condition that involves major high and low shifts of your mood and energy, intermingled with times of mood stability.
Periods of unusually elevated and agitated mood in bipolar disorder are known as mania or hypomania. Exceptionally low energy and persistent feelings of sadness or despair are features of depressive episodes.
Bipolar disorders are diagnosed based on the severity and type of mood symptoms you experience. Bipolar I and II disorders can be further defined by how rapidly you experience major mood shifts.
Ultra-rapid cycling in bipolar disorder refers to the frequency at which you experience mood episodes.
It falls under the specifier of “rapid cycling,” in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), which indicates you experience more than four major mood episodes annually.
Specifiers are informative labels for a diagnosis that help relay important information about a condition.
Ultra-rapid cycling isn’t a formal specifier in the DSM-5-TR, but it’s widely used in literature and practice to describe four or more mood episodes occurring within a single month, with cycle lengths of days, a week, or as frequently as every 48 hours.
Ultra-rapid cycling is included under the diagnosis of rapid-cycling bipolar disorder (RCBD), as is ultra-ultra-rapid cycling (24-hour mood shifts) and ultra-maximal cycling (hourly mood shifts).
Ultra-rapid cycling doesn’t indicate mood symptom severity, only frequency and duration. The DSM-5-TR states that features of mood episodes in rapid cycling are identical to those seen in a nonrapid cycling pattern.
This means the classic symptoms of bipolar disorder — depressive episodes and mania or hypomania — are present in RCBD, just occurring more frequently than what’s typical.
“People move from experiencing signs of depression to experiencing symptoms of mania or hypomania in the space of just a few days, a day, or a few hours,” explained Dr. Chanel Johnson, a licensed professional counselor and CEO of Altus Home Counseling in Detroit, Michigan.
Symptoms of a major depressive episode include:
- depressed mood nearly all day, every day
- sleeping too much or too little
- loss of interest in almost all activities, nearly all day, every day
- weight fluctuations
- inability to experience pleasure
- fatigue or low energy
- inappropriate guilt or feelings of worthlessness
- impaired cognitive function
- diminished or agitated psychomotor function
- suicide ideation
Symptoms of mania and hypomania include:
- decreased need for sleep
- excessive talkativeness
- inflated self-esteem or sense of grandiosity
- distractibility
- rapid thoughts
- increased energy and activity levels
- increased risk-taking and pleasure-seeking
Hypomania symptoms are less severe than those of mania and don’t impair daily function.
Experiencing major depressive episodes, mania, or hypomania that come and go within days or a week during the same month is a symptom of ultra-rapid cycling.
The exact prevalence of ultra-rapid cycling in bipolar disorder is unknown. In literature, it’s typically included under the banner of RCBD.
RCBP prevalence is estimated between
Ultra-rapid cycling isn’t a formal diagnosis in the DSM-5-TR. It falls under the rapid cycling specifier, but a doctor or other healthcare professional may still use “ultra-rapid cycling” in communication and record-keeping to help explain your individual bipolar disorder experience.
Mood episode frequency is important to treatment planning, and knowing your mood symptoms are ultra-rapid cycling can help with long-term symptom management.
How ultra-rapid cycling can affect receiving a bipolar diagnosis
It’s possible to live with RCBD and not receive a bipolar diagnosis immediately. According to Johnson, the rate of mood shifts in ultra-rapid cycling can affect the timely recognition of bipolar disorder.
“Someone who is rapid cycling may not meet the criteria for bipolar I or II at first glance due to them not experiencing symptoms of mania or hypomania long enough,” she cautioned.
In typical bipolar I disorder and II disorder, major mood episodes of mania and depression can last weeks or months.
Bipolar disorder, including RCBD, is treated with a combination of medications, psychotherapy, self-management strategies, and psychoeducation. Exact treatment plans can vary depending on your symptom severity and how frequently you’re experiencing mood shifts.
“Treatment should always be tailored to each patient’s needs,” Johnson said. “A diagnosis is never one size fits all. Any differences in treatment for rapid cycling versus typical cycling would be patient dependent.”
She adds that medication in ultra-rapid cycling needs to be monitored very carefully due to how fast expressed symptoms can change.
Bipolar disorders are treated with a variety of medications, including:
- antidepressants
- antipsychotics
- anticonvulsants
- mood stabilizers, such as lithium
According to a
Psychotherapy
Like medications for bipolar disorder, psychotherapy approaches are customized to your specific needs.
Common frameworks used to treat bipolar disorder include:
- cognitive behavioral therapy
- family-focused therapy
- interpersonal and social rhythm therapy
- dialectical behavior therapy
- psychoeducation
Psychotherapy can help you recognize and change unhelpful thought patterns related to mood episodes. It can also provide new options for stress management, self-care, and coping strategies while living with bipolar disorder.
If you’re living with treatment-resistant bipolar disorder that hasn’t responded favorably to medications or psychotherapy, electroconvulsive therapy, the application of electrical impulses to the brain, may help with symptoms.
Ultra-rapid cycling bipolar disorder is RCBD with major mood episodes occurring multiple times within the same month, sometimes lasting only days.
Although ultra-rapid cycling isn’t a formal diagnosis, it’s a description regularly used in practice and literature to help bring clarity to your unique bipolar disorder experience.
