Rapid cycling

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In the past few weeks I’ve been struggling to keep up with myself. My moods, which usually last weeks, if not months, are flipping back and forth between hypomania and severe depression, leaving me feeling entirely out of control. It’s just too changeable for me to get a handle on. Above you will see a HIGHLY SCIENTIFIC graph of my pattern for the last few weeks from 22nd Feb to today. You’ll see that the highs are very mild (yes, I’m a little elated, extra productive and I feel happy to be me, but that’s it) and that I can move from just above baseline down to suicidal very quickly. The graph is too cumbersome to show exactly how fast my mood can dip, but it can be a literally matter of minutes. Somehow, despite being on the maximum dose of quetiapine, I have become a rapid cycler – and not the kind that wins medals in an Olympic velodrome.

The definition of a rapid cycler is actually anyone who has four or more acute episodes in a year, but that depends on how you interpret the phrase “acute episode” – does this mean just about noticeable others, or is an “acute” mood state one that’s severe enough to disrupt functioning? Either way, many rapid cyclers experience moods switches a lot more frequently than several times a year. Some have mood states that last just a few weeks, while others cycle every few days or even several times within a day, earning them the title “ultra rapid cyclers.” According to Bipolar UK, 10-20% of people with bipolar are rapid cyclers and a disproportionate number (70-90%) are women. Despite this there doesn’t appear to be any evidence that hormones are implicated since it’s just as prevalent among post-menopausal women.

What does all this mean for me? I really don’t know, but I am finding all this flipping back and forth extremely different. Even when I feel good, as I do today, I’m nervous. How long with it last? Is it safe to relax into this mood? It’s scary knowing that I could slide down into suicidality literally at any moment. My self-management plan has gone out of the window – why would I want to try and pull myself down out of mild hypomania today, when I was in deepest despair only last night? I have no idea what to do for the best and my psychiatrist’s not around at the moment. During the lows I am just this side of crisis. If things get worse, I guess I’ll have to present myself to the emergency duty team, which is something I really don’t want to do.

In the meantime, I know people mean well in reminding me that my periods of wanting to end my life won’t last long. That’s true. But it’s also pretty much the problem. I have a graph of where I’ve been but no map of where I’m going, and I’m scared of what tomorrow may bring.

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About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
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15 Responses to Rapid cycling

  1. That’s so nice of you, thanks! Blogging about it helps a bit, as does connecting with others x

  2. Liz says:

    I discovered today that you had posted my email. Thank you that means a lot to me. Thank you for writing about your feelings. It helps me to think about my suicidal feelings when all I want to do is feel positive.

  3. Sue Robertson says:

    I’m following your blog with great sympathy and interest. I lost my partner to suicide 3 years ago-she wasn’t willing to go for formal diagnosis but showed strong signs of being bipolar.I know from being with her how hard it can be, but do hope you will find a way through.

  4. I have Borderline so have been experiencing rapid cycling for years. It sucks, so I can understand why you feel so hopeless about it. I still haven’t learned to ride the wave on the downward spiral but I do enjoy getting stuff done on the upward. I hope that the rapid cycling slows down for you. Sometimes it’s just having that little bit of space to breathe during our moods than can make all of the difference.

    • Thanks, Tegan. It’s the fact that it’s really new for me that’s getting to me…every time I think I have my mood patterns worked out and have strategies for dealing with them, the bam! Something else pops up. Last it was paranoid delusions, now this. Can’t help but wonder what’s next…! xx

  5. Kat says:

    Typically people I have worked with still tended to have the ‘one week or more’ type episode for it to constitute rapid cycling – they just had more of these episodes per year. Also, if their moods fluctuated within days or minutes, and they were on high doses of mood stabilisers or antipsychotics with no effect, they’d receive a diagnosis of Borderline Personality Disorder.

    Although to be honest what’s in the name? I’m sure you are well-versed about DBT, which can be useful for moods in bipolar, bpd and depression – the principles are well worth reading about, especial for emotion regulation difficulties :). I think they’re great! xx

    • Actually the name is incredibly important to me. This is part of my bipolar experience, and I find it really frustrating and unhelpful to have that questioned. Clearly I haven’t suddenly developed a personality disorder in a week at the age of 39, after 28 years of bipolar, so this is bipolar stuff. There seem to be plenty of references to ultra-rapid cycling out there on the web and I have come across plenty of people via social media who have a diagnosis of rapid cycling bipolar and switch across hours or days.

  6. Gershon Brooks says:

    This is so familiar, I also get rapid cycling. Scared of what will be tomorrow or even the next hour. Am I allowed to enjoy myself? How high am going to go? Always wondering if doing something fun is going to push me into the no control zone.
    Then I Speed downward like a helter skelter ride and I struggle to slow my descent. Even though logic tells me I’ve ridden this before and it’s only temporary, I’m always scared that I may lose control and start acting on my self harm and suicidal thoughts.
    I was diagnosed 2 years ago and I’m still trying to figure out my triggers and warning signs but sometimes there doesn’t seem to be any!
    Thanks for this column, you have really helped me a lot, sometimes just knowing that I am not alone in this helps me immeasurably.

    • Great to hear that, Gershon! I thought I’d just write a little post on it a) to help me think through what’s going on and b) because it’s a topic that doesn’t get as much attention as it should. I think it’s definitely harder to work out triggers when you are flip-flopping so fast you barely have time to draw breath. Right now I can spot things that are pulling me up, but then they’re still there and I end up hurtling down. I can’t tell why and that makes me feel powerless!

  7. Firstly, I would like to say that have gained so much from reading your blog. You write so well about the problems that some of us face.
    My cycles are rapid, and you are quite right. Its a worry when one enters the slightest of good moods, because the fear of it quickly plummeting into despair is always present. I do try that ‘live in the moment’ stuff, which can help, when I can do it. But quick cycles = lots of fear. Of course, type 1’s experience fear as well, and I’m not making a comparison. I’m just stating my experience of it.

    • Thank you so much for your kind words. I don’t think it’s as simple as type I and rapid cycling being always mutually exclusive – although to get a diagnosis of BPI you have to be in mood states for at least weeks, I am living proof that you can usually spend months or weeks in a mood state, then have a period of rapid cycling. The boxes aren’t as neat as the diagnostic manuals would always have us believe! TBH although I am not enjoying this, it’s nowhere near as horrific as my past patterns. I can just about live through this, but it’s highly unpleasant and I don’t think I can sustain it for long. But on a horribleness scale? It’s nothing really compared to a mixed mood episode. That is what I fear more than anything, because it’s a kind of living hell. I’m just struggling with this right now because it’s totally new to me and I don’t have any coping strategies for switches this quick and I’m not best pleased to have something new in the mix. It’s really had to keep up :-/

  8. roper says:

    I also rapid cycle. My mood can deteriorate quickly so have learnt to try and be vigilant. I can not always foresee triggers but do my best and try to counter the balance with certain changes. If my mood appears to be dropping I will try and be active, eat well or exercise. if my mood is shooting up I will do the opposite. As I can hit a high and low over a few weeks it does tend to mean I can get away with most people noticing, or it affecting work too much. The hard ones are when it just happens, like a power cut. The lights are out and I’m fumbling around in the dark trying to find some sort of light source. I have found an advantage of rapid cycling is I can sometimes remember the last time I was up or down. I can sometimes remember what I did, good or bad, and try and ease myself through it. Almost like I remember where I last had the torch and can get to the fuse box more quickly.
    Thank you for your blog, it has helped me through some difficult times, up or down.

    • Great metaphor there! I feel generally like I am stumbling around in the dark and I *just* think I’m starting to see, when – something new happens. First it was switching from a BPII pattern to more like BPI with mostly highs and mixed moods. The the paranoid beliefs joined the party. The completely unexpected deep depression. Now rapid cycling. Every time I change my management plan to try and keep up, the symptoms change again! x

  9. Sarah says:

    I am a university student researching in to bipolar. It is a great read, thank you. Would I be able to reference this?

    Sarah

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