Tags

, , , , ,

Rapid cycling, as defined by the almighty DSM-IV, means having more than four mood episodes in a year. Four? Really? Where does that cutoff come from? These and many other questions about rapid cycling go unanswered. Ultra-rapid cycling isn’t well defined at all; apparently it’s somewhere in between rapid cycling and ultradian cycling, which means more than one mood in a day. I think ultradian sounds like a hipster word, but apparently it’s related to circadian, so I can’t make fun of it.

So the standard version of manic depressive illness would involve less than four mood episodes in a year. Presumably “normal” (euthymic) states don’t count. That would be like having a 3-month depression, stability for most of the year, 2 weeks of mania, some more stability, and another month of depression. Or something like that. The potential variations are endless.

Trimpers Cobra Roll by Scott Ableman, CC BY-NC-ND 2.0.

I’m definitely in the rapid cycling category. Ultra-rapid cycling? No idea. None of my psychiatrists has ever bothered to determine anything about cycling, at least not that they’ve told me (par for the course). I go through a lot more than 4 mood episodes in a year. But that falls into a gray area where I’m really not sure how good of a judge I am of it, though. I can’t even imagine dealing with ultradian cycling. Sometimes I feel like I have mood swings at that level – but not with the intensity that I’d associate with a mood episode.

Interestingly, another blogger pointed out to me recently that not only is bipolar II much more likely to involve rapid cycling, but women are also much more likely to have rapid cycling. This ties – to some degree – directly to hormonal cycles as well. I can confirm that: what most people call PMS can be a 5-8 day plunge into misery as my estrogen and progesterone levels drop. Soon I’m crying all day, which worries and irritates me to no end. When I took oral contraceptives, a disastrous and short-lived experiment, I had massive mood swings that may have been the trigger for bipolar.

Another tension with these definitions of rapid cycling is that they can conflict with the definitions of depression, mania, and hypomania in the DSM. A hypomanic episode is supposed to last at least 4 days, and a manic episode at least 7. A depressive episode is supposed to last at least 2 weeks. Anyone who is ultradian is therefore not bipolar by these definitions – which is why they might not be diagnosed as such or receive appropriate treatment. Ultra-rapid cycling, depending on the duration of cycles, might also disqualify someone for a bipolar diagnosis. See the problem?

While I’m on that topic, there’s also the issue of duration of episode being one of the defining markers of hypomania versus mania. I’ve definitely had “up” episodes that lasted a week or more. But were they really mania? It seems that intensity is more relevant there, which is not exactly what the DSM guidelines suggest. And even if intensity of symptoms were the deciding factor, it’s still a subjective judgment.

From everything I’ve read, it appears that the expectation is that rapid cycling is not a permanent thing, because I’ve seen it stated that such-and-so-many bipolars will experience rapid cycling in the course of their illness. Medication is supposed to reduce the frequency and intensity of episodes, which could slow down cycling if that were true, and I’ve seen claims that certain medications reduce or eliminate rapid cycling. My experience has not entirely borne that assumption out. Yes, the intensity is less overwhelming, but the pace doesn’t seem to have changed much. Breakthrough depressive or manic symptoms are brief enough that seeing a psychiatrist to tweak meds doesn’t make sense, so unless someone gives me leave to adjust meds myself as needed, I’ll just have to tolerate the milder mood swings.

I’m not sure that I’d want slower mood cycles. A 3-month depression is so much harder to tolerate than a 3-week depression. I suspect rapid cycling is one of the reasons that my depression has been less severe in recent history. It doesn’t have time to get so bad for so long that I lose hope completely. Just mostly.

Advertisements