Understanding the symptoms, causes, and triggers of rapid cycling in bipolar disorder

Understanding the symptoms, causes, and triggers of rapid cycling in bipolar disorder
Rapid cycling can take an immense toll on someone's quality of life and may cause loss of employment and relationships.Thanakorn Suppamethasawat/Getty Images
  • Rapid cycling is a symptom of some bipolar patients that causes them to cycle through four or more episodes a year.
  • Rapid cycling may be caused by substance abuse, severe life stressors, or trauma.
  • Stopping medication, using antidepressants, and sleep disturbances can trigger rapid cycling.
  • This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist, and director of the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John's Health Center.

Rapid cycling is a symptom associated with bipolar disorder where patients quickly cycle through episodes of mania and depression. An average of 12% to 24% of people with bipolar disorder experience rapid cycling, and it is more common in women and children with the disorder.

What is rapid cycling bipolar disorder?

Bipolar disorder is a mental health condition that affects about 5.7 million adults in the US every year and is characterized by periods of depression and manic highs. Rapid cycling is a symptom of bipolar disorder where these episodes of depression and mania happen at least four times a year.

These episodes tend to be short, with another occurring fairly soon after, hence the name rapid cycling. By contrast, people who are bipolar who don't experience rapid cycling typically have episodes that last weeks or months.

All bipolar disorder patients generally experience grace periods of normal mood in between episodes of depression and mania, but these periods are shorter for rapid-cycling patients.

Rapid cycling can occur in both bipolar 1 and bipolar 2 patients. With proper treatments such as medication and therapy, rapid cycling can be managed.


What are the risks of rapid cycling?

Experiencing multiple depressive or manic episodes can take an immense toll on a person's life.

According to Lea Lis, MD, a board-certified psychiatrist with a clinical practice in Southampton, New York, rapid cycling can lead to the following:

  • Loss of employment
  • Failed relationships
  • Divorce
  • Problems maintaining social relationships

Rapid cycling not only disrupts the quality of life but it can be life-threatening, as well. A 2003 study published in JAMA Psychiatry followed 345 people with either bipolar 1 or 2. Of those studied, 89 experienced rapid cycling. Researchers determined that this condition put them at more than twice the risk of attempting suicide.

However, the same study found that in four out of five cases of rapid cycling, it stopped within two years of its first occurrence. Researchers are unclear why the condition resolved on its own, but believe rapid cycling may be only temporary for some patients.

What causes rapid cycling?

While researchers are still unsure exactly what causes rapid cycling, Lis says the risk factors to developing the condition are:

  • Substance abuse
  • Severe life stressors
  • Trauma
  • Family history
  • Younger age at the time of bipolar onset

What triggers rapid cycling?

Rapid cycling appears to be triggered by both internal and external influences. A number of factors can trigger rapid cycling, some of which are more preventable than others. According to Lis, these primary triggers include:

  • The use of substances such as amphetamines, alcohol, or marijuana.
  • Skipping doses or stopping medication prescribed by a doctor.
  • Use of antidepressants without a concurrent mood-stabilizing medication.
  • Genetic differences that may cause sleep disturbances.
  • Conditions such as hypothyroidism which is when the thyroid does not produce enough hormones or traumatic brain injury.
  • Severe life stressors like childhood trauma or divorce.

How to treat rapid cycling

In order to successfully treat for rapid cycling, treatment plans must also address the underlying bipolar disorder symptoms.

Consistent therapy can teach patients coping skills — habits which people can integrate into their lives that help them deal with the issue at hand, says Anandhi Narasimhan, MD, a board-certified psychiatrist with her own private practice in Los Angeles, California.

For rapid cycling, coping skills that patients may find beneficial include getting a full eight hours of sleep, attending a support group, or journaling.

Generally, the use of antidepressants, especially for an extended period, is not advised for patients who experience rapid cycling, says Lis, as they may exacerbate symptoms.


Instead, she says mood-stabilizing drugs such as lithium or Depakote tend to be better treatment options for preventing future episodes as they decrease abnormal brain activity responsible for episodes.

However, doctors must monitor patients closely to ensure they continue the proper intake of these mood stabilizers and do not forego them if adverse side effects, such as weight gain, occurs, says Lis.

Read more about how to treat bipolar disorder.

The bottom line

Rapid cycling is a symptom of bipolar disorder that some, but not all, people experience. It cannot be cured, but with proper medication and therapy, it can be managed.

"Symptoms can wax and wane at different times in life without treatment and sometimes with treatment when a person is faced with stress," says Narasimhan. "Maintenance treatment can help prevent future episodes or at least mitigate the severity of symptoms."


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