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Rapid Cycling in Bipolar Disorder

Reviewed by: HU Medical Review Board | Last reviewed: August 2023

People with bipolar disorder (BPD) who have 4 or more episodes of mania, hypomania, or depression in a year are said to have rapid cycling. These mood changes may happen every few hours, days, or months.1,2

Between a third and a half of people with BPD develop rapid cycling at some point. There is no pattern to how often these cycles happen. For most people, rapid cycling is temporary. But some people experience rapid cycling that never stops. Four or more mood changes within 1 month is called ultra-rapid cycling.1,2

Rapid cycling is more common in women, especially those who developed bipolar symptoms earlier than average or who have developmental disorders like autism. Rapid cycling is linked to a higher risk of suicide.1,2

What triggers rapid cycling?

Doctors do not know exactly what causes rapid cycling, but they have a few theories.

Kindling theory

Kindling is a type of dry wood or other material that catches fire easily. The kindling theory proposes that stressful events early in life trigger rapid cycling, but those events are not necessary to trigger a cycle later in life. Sometimes just the fear or expectation of a stressful event can act as a trigger. Examples of triggers are job loss or loss of a loved one through death or a breakup.1

If a person with BPD experiences an event like their "kindling" event, or even thinks it might happen, rapid cycling may result. Rapid cycling may increase if the triggers continue to appear.1

Circadian rhythms

Circadian rhythms are biological rhythms or patterns that every person has over a 24-hour period. Circadian rhythms keep people’s activities like eating and sleeping aligned with the patterns of their life.1

The biological rhythms theory proposes that people who have rapid cycling are out of alignment with their circadian rhythms. Since good sleep habits help manage bipolar episodes, some doctors believe this theory.1

Thyroid imbalance

The thyroid is a gland at the front of the neck that controls some of the hormones that affect metabolism. Thyroid conditions do not regulate these hormones correctly. Some people with rapid cycling get better when they are treated to correct the error with their thyroid function.1,3

Antidepressants

It may not seem to make sense that someone who is depressed should not take antidepressants. However, antidepressants can lead to more frequent episodes of mania. If someone is already at risk of elevated moods, increasing their mood with an antidepressant can make things worse.1,4

For this reason, mood stabilizers are the treatment of choice for people with BPD. Some people with mania may also need antipsychotics.1,4

Therapy and keeping a mood diary

Rapid cycling can be disabling, and it is linked to worse outcomes if it goes untreated. In addition to treatment with mood stabilizers, talk therapy and self-care can help too. Seeing a therapist can help a person with BPD stick to their treatment plan. It can also help them learn to recognize when symptoms are getting worse and what makes them better.1

One suggestion a therapist might make is keeping a mood diary. This is an important part of learning to recognize your personal triggers. Over time, a mood diary can help you identify stresses that triggers mood swings.1

A mood diary tracks lifestyle factors like:1

  • The times you go to sleep and wake up
  • When and what you eat
  • How often and how long you exercise
  • Any alcohol or drug use
  • If you experience specific stress

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