Rapid cycling is not a fast ride on a unicycle, although it may certainly be close the experience. The fact is this is the most disabling type of bipolar disorder and the most difficult to treat. During such episodes people are more likely to need hospitalization and are most at risk for suicide.
Most people with bipolar disorder will have one episode of major depression or mania in a year. Some people have episodes of mania, hypo-mania or depression four or more times with in a year. Cycling between them may occur as frequently as days or hours. Other conditions may seem like rapid cycling but without the full number of symptoms that define either depression or mania. Examples include withdrawal from alcohol or drugs, PTSD, emotional liability in response to life events, traumatic brain injury or even brain tumors.
Interestingly, rapid cycling is more likely to occur in those with bipolar II disorder. Fifty-per-cent of individuals with bipolar disorder will have at least one episode of rapid cycling in a lifetime. In most cases this condition is temporary and more typical frequency of highs and lows occurs. Ten per cent of bipolar patients will have this condition exclusively.
Rapid cycling is more likely to occur when people are first diagnosed with bipolar disorder as treatment might be delayed. On the other hand treatment with too much antidepressant not only can lead to mania but also rapid cycling. Emphasis should be on a combination of a mood stabilizer such as lithium or lamictal with an antidepressant.
One theory is called kindling. Initially a major life stressor may lead to depression or mania and as time goes by less and less stressors may lead to this condition. The second theory involves too frequent interruption of circadian rhythm such as when changing time zones occurs too frequently as in bipolar businessman who fly frequently. Seasonal affective disorder may lead to rapid cycling in areas of dramatic shifts between long nights and long days such as far longitudes. The anxiety associated with both theories often implicit insomnia for which a benzodiazeping may be required.
Some terms relating to frequency of depression and mania include ultra fast mood swings when episodes occur in a matter of days and ultra-ultra rapid cycling when mania and depression occurs within a single day. Note: When this happens seek medical help immediately.
The treatments for this are the same as for typical bipolar disorder but may require frequent adjustments by a psychiatrist on a weekly basis and with easy access by phone in between if necessary. In an ideal world the above would be easy but in this day and age of limited visits by health insurances, lack of accessibility to health insurance as in Medi-Caid or medically indigent adults makes this not an ideal world indeed. One can get care for labile diabetes or heart failure much more readily than for psychiatric disorders in general.