Rapid Cycling Bipolar
My psychiatrist once compared rapid cycling bipolar to a ride at the fair: once it starts, it picks up speed and the faster it goes, the harder it is to slow down. She couldn’t have been more right. However, I would add that the faster it goes, the more devastating the effects can be.
What Is Rapid Cycling Bipolar?
About 10 to 20 percent of people with bipolar may experience rapid cycling. It is diagnosed after four episodes of depression, mania or hypomania occur within a year. Some will also experience the dangerous mixed state where depressive and manic symptoms are present at the same time.
Rapid cycling bipolar is more common in women and in those whose first episodes occur in childhood or adolescence.
Some people experience ultra-rapid cycling bipolar, where their episodes change daily, or ultradian rapid cycling, where they experience a number of mood episodes within a day.
Unfortunately, rapid cycling suggests poor treatment response and can make treatment even more challenging.
What Were My Symptoms?
I will say one thing: change is inevitable.
I lived for some time with a dark feeling in my stomach, which I dealt with through an eating disorder and bingeing on drugs on the weekend.
In truth, I was living behind a screen where I felt out of touch with the world. A final intervention from friends took me back to my home town where I broke down.
Looking back, I was deeply depressed but highly functioning. It wasn’t until I was given a selective serotonin re-uptake inhibitor (SSRI) antidepressant that something scarier triggered.
I couldn’t get out of bed and my thoughts flashed graphic images of suicide and self-harm. My body felt different and my eyes stared.
I was taken back to the doctor who changed my antidepressant without a safe wash-out period, and this reaction unfortunately triggered serotonin syndrome, a rare poisoning of the nervous system. It was this catalogue of chemical events that my psychiatrist believes fuelled my rapid cycling bipolar back in June 2008.
I became so out of control I was flying from manic episodes to suicidal depression within hours. When I closed my eyes my mind would rest between a state of sleep and awake only to trigger another mood episode. It was like living on another planet.
I couldn’t sleep. At 3 a.m. my mind would be so alive and my body would be bursting with so much energy I would skip in the garden for hours with dance music blaring in my ears.
There was no time to eat and I didn’t consider it. I would speedily talk with ideas about building businesses and if anyone interrupted me I would dismiss them irritably.
Within hours I would be on the sofa and it was as if the weather had radically changed. I struggled to move and cried until I couldn’t see through the tears.
What Were My Symptoms?
I had been given a mental health helpline number and I used to call and sob to the soothing voice who reassured me I would be OK. I was so low I wanted to die and continually said, “My heart hurts."
The highs became more euphoric. I would walk with purpose to a grassy area by our house with my favourite things, including a family photograph. Everything had incredibly strong meaning to me and I was flooded with creativity.
I used to write poetry in seconds and feel at one with the incredible world in which I lived. The color of the grass was more vivid than I had ever seen and it felt as though I could see the fine detail of every insect.
It was here I felt I understood the world with grandiosity. I believed life was a chessboard and people were simply moved around by God or a higher being.
I felt I had an invisible, yet deep, relationship with this higher being. Invincibility went hand-in-hand with these feelings. I was fearless and shoplifted without care. I also remember standing at the curb telling myself I could jump in front of any of the cars.
My creative flairs became more fast and furious and my concentration would be held for hours and hours doing the most intricate and exhausting activities.
I ran out of glue once and my mum bought the wrong replacement. I threw it against the wall, screaming vile names at her and sobbed. It felt as though my life had been ruined. The depression would set in once again and I would drag myself back to the sofa wishing I would just die.
Effects of Rapid Cycling
Rapid cycling can be extremely destructive and unfortunately, can cause irreparable damage. Thankfully my family and friends now understand it, but only through experience. They recognize that sobbing, suicidal, irritable and energetic are signs and symptoms of a girl who is rapid cycling and does not represent the Fliss they know and love. Without that knowledge I can be unrecognizable when unwell.
I lost the relationship with the man I loved who, although instigated part of my depression, wanted nothing more to do with me after my incessant texting when high and then when suicidal.
Embarrassment is hard to stomach. The wonderful floaty highs feel great, and in these states I have openly flirted with married men while dressed provocatively. I was carefree and in love with the world, what did I care?
My irritability was a nightmare, too. I once shouted abuse at a woman at the pharmacy for not having my medication and was told by my dad to go back and apologize. The realization of both these occasions slammed me back down to earth and I loathed myself, turning to self-harm for relief. Neither mood ever lasted and I was in a constant state of changeable confusion.
A long-term impact of my compulsive spending on anything and everything I liked, ranging from sunglasses to iPods, is debt. As long as I had a credit card, the money was available to spend. While in hospital I was still ordering packages of new clothes that arrived every day before my laptop was confiscated to protect me. I am still left with that debt I attempt to pay off slowly.
I am now trying to clear it with medical support supplied to the bank from my psychiatrist. It is upsetting because financial stress has contributed to my depressive periods, yet there is nothing I could have done to prevent it at the time.
Effects of Rapid Cycling
I was a loose cannon and danger to myself and my personal and professional relationships. I had the power to destroy anything I touched and it was completely out of my control.
Spotting Signs and Symptoms
The only way I can spot when rapid cycling is coming on is through mood charts, which were recommended by my psychiatrist. The highs and lows were so obvious they were impossible to ignore.
If I spot a rapid cycling pattern emerging I report it to a professional to aid prevention. It is important to talk to them about your feelings and thoughts and I would recommend taking a family member or friend who can back up your out-of-character behavior.
Treatment for Rapid Cycling Bipolar
Mood stabilizers, such as lithium, are the usual treatment and are 20 to 40 percent effective in rapid cycling cases. Some antipsychotics work, but medication is all very dependent upon your psychiatric treatment plan.
It is commonly reported that antidepressants can provoke rapid cycling, which happened to me. We often report only our depressive symptoms so people with bipolar are often diagnosed with depression initially.
It is so important to report any symptoms if you think, feel or behave differently to your usual self. Rapid cycling bipolar is destructive and has an aggressive onset that can become very difficult to treat. If we spot the signs earlier we can get help sooner.
What Helped Me?
The following helped me when confronting my rapid cycling bipolar:
- Reporting symptoms to a doctor and/or psychiatrist.
- Going back to basics: implementing a proper sleep routine, drinking lots of water, eating regularly, and taking medication properly.
- Recognizing that there are many triggers in life I am vulnerable to.
- Monitoring moods to avoid important things when my behavior could have significant impact.
- Avoiding overstimulation: social situations, loud music and big crowds.
- Keeping my hands busy, either by painting my nails or going for a walk, to avoid exacerbating manic symptoms .
- Educating those around me and requesting their patience while I get well.
- Staying hopeful and continually reminding myself to ride each mood out, ideally in safe environments where I am accepted and understood.
It is easy to try and control the rapid cycling yourself through alcohol and drugs, whether they are recreational or prescription — I’ve tried. The short-term gain is nothing compared to the long-term devastation.
It is really important not to push yourself during rapid cycling and get treatment immediately. I have increasingly more stable periods and I know what to expect now so can spot any signs or symptoms earlier. Ultimately, I do my best to prevent rapid cycling episodes with personal and professional support.