Rapid Cycling




"Rapid cycling pattern carries a poor prognosis and may affect up to 20% of bipolar patients." (DSM IV)

  • Diagnosis requires the presence of at least 4 mood episodes within 1 year.
  • Episodes may include major depressive, manic, hypomanic or mixed.
  • The patient must be symptom-free for at least 2 months between episodes or the patient must display a change in mood to an opposite type of episode. (DSM IV)

The above is from the Diagnostic and Statistics Manual and is the official description of rapid cycling, however, though it appears in this bible of the psychiatric professional, many of the same professionals disagree and find the description too narrow to adequately account for what their patients report and experience. There is much research in progress now to better understand the phenomenon, and so it is becoming more accepted to talk of rapid cycling as something that can occur far more often than 4 times a year and with "at least 2 months between episodes." In fact, many bipolars suffer through cycling as often as every few hours and these cycles are now being seen for what they are i.e., discreet examples of rapid mood change. The rapid-cycler is truly the mercurial epitome of what it means to be bipolar. The quick changes can be completely debilitating and the person may find it impossible to maintain work, school or relationships.


If you can imagine feeling on top of the world one minute and then ready to go in search of the razor blades in the next only to flash into a full-blown rage for no apparent reason then you will have some minute idea of what it is to be a "rapid cycler." Periods of rapid cycling may occur following long periods of apparent normalcy or they may be an ongoing aspect of the illness. Many bipolar folks do not start out as being rapid-cyclers but are made such by having been prescribed antidepressants unopposed by a mood stabiliser such as lithium, carbamazepine or divalproate. It is so important that the right diagnosis be made and that an unopposed antidepressant isn't given as this will likely spike a manic mood state that can be devastating.  Whenever bipolar is suspected or indicated by family inheritance extreme caution as to what is prescribed and why is crucially important.




Some informative links to literature on rapid-cycling...