Rapid Cycling Bipolar Disorder: Symptoms, Causes, and Treatments

Bipolar disorder is a mental health condition where you have mood episodes like mania, depression, and hypomania. When you have bipolar disorder, these mood episodes come and go over time. Some people will only have a couple of mood episodes in their whole lifetime. Other people have them much more often. 

Some people with bipolar disorder can even have a lot of mood episodes every year. When this happens, it’s called rapid cycling bipolar disorder. If you or someone you care about has this type of pattern, you may have some questions about what it means — including symptoms, risk factors, and how it can be treated. 

What is rapid cycling bipolar disorder?

Rapid cycling bipolar disorder is bipolar disorder 1 or 2 with four or more mood episodes per year. About 25% of people with bipolar disorder may experience rapid cycling at some point in their lifetime.

With rapid cycling bipolar disorder, you can have mood episodes in any order. For example, you may cycle between manic episodes and periods without any symptoms. Or you could cycle between manic and depressive episodes.

Some people experience rapid cycling only at certain times in their life. Others almost always experience rapid cycling.

What are the symptoms of rapid cycling bipolar disorder?

Rapid cycling bipolar disorder shares the same symptoms as bipolar disorder. 

Bipolar disorder is a mental health condition where you have recurring mood episodes that come and go over time. There are two main types: bipolar 1 and bipolar 2. Some people with bipolar disorder only have a few mood episodes in their whole lifetime. 

But a person with rapid cycling bipolar disorder experiences much more frequent mood episodes — typically four (or more) per year.

Other than that, the mood episodes are pretty much the same.

Mood episodes in bipolar disorder include:

• Mania

• Hypomania

• Depression

A manic episode lasts for at least 1 week and includes symptoms, such as:

• Feeling highly energetic

• Not sleeping

• Talking faster than usual

• Making or acting on larger-than-life plans

• Being very irritable

This is more extreme than simply being in a good mood. It also can lead to risky behaviors and impulsive behavior, like driving drunk or gambling large amounts of money. The behavior is extreme enough that it interferes with a person’s work and personal life. Sometimes, people have manic symptoms that are less severe. Such episodes are called hypomanic.

Someone with bipolar disorder may also have periods of feeling very down and depressed. These are depressive episodes that last 2 weeks or more. They include symptoms like:

• Depressed mood

• Loss of interest in favorite activities

• Changes in your sleep patterns

• Trouble with concentration

• Feeling worthless or guilt that’s not warranted

What is ultra-rapid cycling bipolar disorder?

Ultra-rapid cycling is when you have even more frequent mood changes — four or more per month. Though it’s not an “official” mental health diagnosis at this point, it’s clear that some people do experience this type of pattern. Some people even have mood changes as quickly as every 1 to 2 days. 

It’s not clear yet whether ultra-rapid cycling bipolar disorder should be its own diagnosis, or if it’s something else completely. Some experts believe ultra-rapid cycling might actually be related to borderline personality disorder. Other experts feel that it’s a subtype of bipolar disorder. We’ll need more research before we can know for sure.   

What causes rapid cycling bipolar disorder?

We don’t know exactly what causes rapid cycling bipolar disorder. It may be related to differences in the structure and function of your brain. It may also be partly due to genetics: The condition sometimes runs in families.

Here are some other possible factors that may add to rapid cycling:

• Taking antidepressant medicine without a mood stabilizer: In some people, rapid cycling may be linked to antidepressants — especially in people who aren’t taking a mood stabilizer. An antidepressant used alone may add to manic episodes. A combination of antidepressants and mood stabilizers is sometimes used instead.

• Experiencing sleep issues: Rapid cycling mood episodes may also have to do with sleep. In people with bipolar disorder, poor sleep might trigger an episode. In turn, a mood episode can make it hard to sleep, creating a cycle that makes things worse.

• Thyroid problems: Hypothyroidism — when you have low levels of thyroid hormones in your body — is also linked to rapid cycling. Lithium, a medication used to treat bipolar disorder, can also raise your risk for hypothyroidism.

• Using drugs and alcohol: Substance use and misuse are connected with a higher risk for rapid cycling mood episodes.

• Developing bipolar disorder before age 17: Some research suggests those who develop bipolar symptoms early in life are more likely to experience rapid cycling.

What are the risks of rapid cycling bipolar disorder? 

Rapid cycling bipolar disorder is connected to serious health risks. Those who experience frequent mood changes may be more likely to misuse substances. They may also be more at risk for suicide attempts.

It’s not clear if these conditions are caused by rapid cycling — or if it’s the other way around. But, it’s important to know about the connection and to get medical help when needed.

What’s more, people with rapid cycling bipolar disorder may be at higher risk for having symptoms longer than those without rapid cycling bipolar disorder.

How do you treat rapid cycling bipolar disorder?

Treatment for rapid cycling bipolar disorder isn’t much different than treatment for other types of bipolar disorder. But, rapid cycling bipolar disorder is sometimes considered difficult to treat. This may be because manic and depressive symptoms are so different and can occur in relatively quick succession.

Medications are the main treatment for bipolar disorder. Medicines may help prevent rapid cycling and mood episodes. And they can help treat the symptoms when they occur.

Medications for rapid cycling bipolar disorder

There are many different medications that are used for bipolar disorder, including rapid cycling bipolar disorder. It all depends on your unique symptoms, your past episodes, and which medications have worked well for you previously. 

Medications commonly used to treat rapid cycling bipolar disorder include:  

• Mood stabilizers: These are medications that can help to treat and prevent mood episodes. Mood stabilizers used for rapid cycling bipolar disorder include lamotrigine, valproate, carbamazepine, and lithium. 

• Antipsychotic medications: These are medications that are used to treat the symptoms of depression and mania, and to prevent mood episodes. Antipsychotics used to treat rapid cycling bipolar disorder include risperidone, aripiprazole, olanzapine, and quetiapine. 

• Antidepressants: These medications are sometimes used to treat depression in rapid cycling bipolar disorder. Most of the time they’re only used if mood stabilizers and antipsychotics haven’t worked, and then only together with olanzapine (or a similar medication). Examples of antidepressants used in rapid cycling bipolar disorder include fluoxetine, citalopram, and sertraline. 

Remember: Each person and their experiences are different. So, work with your healthcare provider to find the best options for you. Make sure to take all your medications as prescribed. And check in with your provider about changes to your symptoms or side effects.

Can therapy help with rapid cycling bipolar disorder?

Yes. Therapy — such as cognitive behavioral therapy (CBT) — may help, especially when combined with medication. Therapy can’t treat all bipolar symptoms directly. Yet, it may help you understand yourself as well as your condition and how to manage it.

What support is available for someone with rapid cycling bipolar disorder?

If you have questions about rapid cycling bipolar disorder, talk with your healthcare provider. Rapid cycling bipolar disorder can be managed with the right treatment and support. By keeping up with medications and other treatments, you can learn to manage your condition and lower your risks.

To find a mental health provider, contact your primary healthcare provider or make an appointment with a specialist, such as a psychiatrist. You can look for a provider through your insurance network or search for providers in your region.

There are also peer-based groups you can try, along with professional treatment. The Depression and Bipolar Support Alliance offers peer meetings through local chapters and online. Visit their website to learn more and look for groups in your state.

The National Alliance on Mental Illness (NAMI) also offers support. The organization offers education about mental health as well as peer support. It’s also organized by chapters. Visit NAMI online and search for groups in your state.

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Written by:

Jennie Bedsworth, LCSW

Jennie Bedsworth, MSW, LCSW, is a licensed clinical social worker and therapist with 20 years of experience in journalism, teaching, and mental health. Prior to completing her master's degree, she wrote for The Furrow magazine and was editor of Missouri Ruralist magazine.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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