Think twice about Ultra-Rapid Cycling Bipolar Disorder (2023)

Important points

  • Bipolar disorders have a high rate of misdiagnosis; Ultra-fast cycling adds another potential layer for misdiagnosis.
  • It can be difficult to distinguish a traditional mixed bipolar state from the proposed ultra-rapid cycling phenomenon.
  • Some personality disorders and PTSD can have periodic, reactive mood swings that can be confused with ultra-fast cycling.

Bipolar disorder has a high rate of misdiagnosis problems (eg, Rakofsky et al., 2015; Shen et al., 2018; McIntyre et al., 2022). This has a lot to do with poor differential diagnostic practice and misunderstanding, even among some physicians, as noted in the post"Agree,"any general bad mood is synonymous with "bipolar". It is commonly misdiagnosed as major unipolar.Depression(e.g. Nasrallah, 2015; Stiles et al., 2018; McIntyre et al., 2022) or overdiagnosed (e.g. Ghouse et al., 2013; Morgan & Zimmerman, 2014; Cogen et al., 2021; Doyen, 2021) Ifpersonality,Trauma, or other items promote atmospheric roller coasters.

Think twice about Ultra-Rapid Cycling Bipolar Disorder (1)

Source: Geralt/Pixabay

WithinBipolar disorderDiagnoses it is not uncommon to see the specifier "with fast cycling", aDiagnostic and Statistics Guide (DSM) and International Classification of Diseases (CIE) award sanctioned. There's also the proposed ultra or ultra-ultra (ultra) fast cycle specifier that wonAttentionover the years, adding another wrench to the tendency to misdiagnose.

As elaborated below, this last notation should raise more doubts about the diagnostic accuracy, as there is an inherent, wavering moroseness inherent in many disorders, coupled with the fact that bipolar disorder is a popular, if constantly misunderstood, diagnosis that lends itself to use suitable for those prone to impulsiveness.Diagnosis based on a main symptom.

Definition of fast cycles

The fast cycle specifier applies only to bipolar types 1 and 2 to define four or moredistinguishableMood swings (severe depression, mania,hipomaníaco, or mixed) within a year (APA, 2013). Such a cycle has been estimated to be present in only 10-20% of people with bipolar types 1 and 2 (eg, Valenti et al., 2015; Bourla et al., 2022), with a frequency of 0, 4–2% of the general population (e.g. Clemente et al., 2015; Rowand & Marwaha 2019). Therefore, readers can easily see that observing rapidly cyclic basic bipolar disorder is a rare phenomenon. On the other hand, Carvalho et al. (2014) found that fast cycling appears to correlate with triggering throughAntidepressantsand hypothyroidism in many.

(Video) How Long Does Rapid Cycling Last? Switching vs Cycling

Also, it's important to note that fast cycling isdistinctly different from cyclothymia,a "soft bipolar" state. Cyclothymia is inherently the cycle of years,chronicCycles of submajor depressive and subhypomanic symptoms about every few days without interruption; the dysthymia of bipolar disorder, if you will.

Ultra-fast, ultradian cycling has never been included in theDSMo ICD as a specifier for bipolar disorder and is still debated (e.g. Swann et al., 2013; Shirazi et al., 2017),

Critical thinking about ultrafast cycling

Anyone who has worked with bipolar disorder knows that expansive mood/affect is a hallmark ofMania. The patient's affective state is often characterized by minute-to-hour oscillations of dysphoric/depressive, irritable/angry, and joyful/joking affects. As this is such an obvious trait and manic people are not necessarilyalwaysRestlessness, rushed/disorganized speech, etc. show the 'full manic package' which oscillation marks and is easy to observemood/affectit can be taken as an indication of significantly altered mood states ("episodes") and thus lead to assumptions of ultrafast/ultradian cycles unless careful diagnostic and observational questions are asked.

Next, as noted above, to be considered fast cycling, distinct episodes must be present, and mood episodes, by definition, last for days to weeks. However, ultrarapid and ultradian cycles are described as a one-day or between-meal mood disorder and hardly meet the criteria for an episode. Also, without the closest observation, doesn't it seem nearly impossible to judge within hours whether someone has met all the criteria for a mood episode, or whether it can be better explained by the jumbled, jumbled mass of utterly jumbled episodes?

Prevalence estimates vary, but up to 40 percent (i.e., Fagiolini et al., 2015) of people with bipolar disorder tend to have mixed episodes. This means that the patient experiences at least some symptoms of depression during mania or hypomania/vice versa. In addition, mixed episodes, such as the proposed ultradian subtype of bipolar disorder, tend to be long-lasting and severe, resulting in a poorer prognosis.

In addition, to mask the problem, it is possible that one of the affect states in a mixed episode may appear periodically more frequently during the mixed period, supposedly indicating different moods. In view of this, Swann et al. (2013) noted that mixed states challenge the concept of ultra/ultra cycling because it is possible that the proposed bipolar ultra/ultra disorder is actually a nuanced mixed episode.

In general, the additional question arises here as to whether another form of bipolar disorder should be considered if one or the other affective state is quickly and sufficiently delineated in a mixed episode. Is ultrafast/ultradian cycling just another term for people who mostly experience long mixed fights?

All of this does not mean that ultrarapid and ultradian cycles are not considered a distinctive diagnostic niche within bipolar disorder. However, there is clearly excessive scope for diagnostic error within the mood disorder category alone, let alone the ultra-fast cycling chameleons in other diagnostic categories.

Think twice about Ultra-Rapid Cycling Bipolar Disorder (2)

Source: Pexels/Pixabay

(Video) What is Bipolar Disorder with Rapid Cycling?

fast cycling chameleons

Consider these people with somepersonality disorder, especially borderline and histrionics, have characteristic, daily changing/reactive moods. this withexpectedThey may also exhibit reactive mood swings. All three are prone to major depressive episodes. These rapidly changing moods, superimposed on a depressive background, may at first glance suggest a rapidly cyclical “bipolar disorder” to those prone to reflex diagnoses based on one main symptom.

Tips for differential diagnosis

Take your timeCover the basics of the diagnostic process.It is misguided and dangerous to subscribe to the notion that a laser-sharp and accurate diagnosis is not important because, ultimately, "we treat the symptoms, not the disorders." Many disorders share common symptoms, but that doesn't mean they're treated in the same way.

To illustrate, Bipolar Disorder and Borderline Personality are notorious for their moodiness, and in over 20 years of practice and supervision I can say that it is not uncommon for everyone to have "coping skills and strategies".medicine"Approach for people who complain of bad mood. For more than weak stability, at least bipolar disorder is requiredPsychiatryand a focus ontherapyabout maintaining good sleep patterns and maintenanceemphasizeto keep in check so as not to inflame the mania. Treating borderline personality requires cultivating more constructive interpersonal relationships throughchange the problematic core schema,which drives his propensity for reactive moodiness.

And therein lies an important differential component: assessing whether significant and regular mood swings correlate with events that would indicate a personality trait. If this is the case, look for signs of borderline, histrionic, or otherGroup Bpersonalities is important. It is also important to assess whether the person has a history of severe trauma that would lend itself to regular temper tantrums and outburstsfearfulReactions that can superimpose depression and supposedly appear as "rapid cycling".

Finally, some "signs" that moody rollercoasters could be bipolar disorder include:

  • There don't seem to be any particular trigger events; bad mood thrives endogenously.
  • The presence ofPsychopathTraits, particularly delusions of grandeur, such as having superpowers or holding important positions, and auditory hallucinations.
  • ANaturallyFamily history of bipolar disorder based on family members' descriptions of clearly alternating manic/hypomanic/mixed/depressive episodes, review of charts, and concomitant contact with providers;NO"I'm bipolar" or "a doctor once told me I was bipolar" at face value.
  • Mood swings occur in absentiasubstance abuseand is not affected by prescription medications, particularly antidepressants.
  • Medical complications such as an endocrine disease or organic damage are not in sight.

Disclaimer: The material provided in this publication is for informational purposes only and is not intended to diagnose, treat, or prevent any disease in the reader or anyone they know. The information is not intended to replace the personal attention of the provider or the formal supervision of an individual, whether a professional or student.


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

Bourla A, Ferreri F, Baudry T, Panizzi T, Adrien V, & Mouchabac S (2022). Rapid Cycling Bipolar Disorder: Review of the Drug Treatment Literature Illustrated by a Case Report of Ketamine.brain and behavior, 12(2).

Carvalho A, Dimellis D, Gonda X, Vieta E, McIntyre R, & Fountoulakis K (2014). Fast cycling in bipolar disorder: a systematic review.Journal of Clinical Psychiatry, 75(6), 578-586.

Clemente A, Diniz B, Nicolato R, Kapczinski F, Soares J, Firmo J, & Castro-Costa E (2015). Prevalence of bipolar disorder: a systematic review and meta-analysis of the literature.Brazilian Journal of Psychiatry, 37(2).

Cogan, C.M., Paquet, C.B., Lee, J.Y., Miller, KE., Crowley, M.D., & Davis, J.L. (2021). Differentiating symptoms of post-traumatic stress disorder and bipolar disorder in adults: using a trauma-informed assessment approach.Clinical Psychology and Psychotherapy, 28(1), 251–260.

Given, P. (2021). Overdiagnosis of bipolar disorder in underserved communities: a call to action.Columbia Social Work Review (19)1.

Fagiolini A, Coluccia A, Maina G, Forgione R, Goracci A, Cuomo A, & Young A (2015). Diagnosis, epidemiology, and treatment of mixed states in bipolar disorder.CNS drugs, 29, 725–740.

Ghouse A, Sanches M, Zunta-Soares G, Swann A, & Soares J (2013). Overdiagnosis of bipolar disorder: a critical analysis of the literature.Scientific World Journal, 2013,

McIntyre, R., Laliberté, F., Germain, G., MacKnight, S., Gillard, P., & Harrington, A. (2022). The real-world use of healthcare resources and the cost of misdiagnosing bipolar I disorder.Journal of Mood Disorders, 316,26-33.

Morgan, TA & Zimmerman, M (2015). Is Borderline Personality Disorder Underdiagnosed and Bipolar Disorder Overdiagnosed? In Choi-Kain, L. & Gunderson, J. (eds.)Borderline Personality and Mood Disorders. Springer, NewYork, NY.

Nasrallah, HA (2015). Consequences of misdiagnosis: inaccurate treatment and poor patient outcomes in bipolar disorder.Das Journal of Clinical Psychiatry, 76(10).

(Video) What is rapid cycling Bipolar Disorder?

Rakofsky, J. & Dunlop, B. (2015). The over-under in the misdiagnosis of bipolar disorder: a systematic review.Current Psychiatry Reviews, (11)4, 222-234.

Rowland, T & Marwaha, S (2018). Epidemiology and risk factors of bipolar disorder.Therapeutic advances in psychopharmacology,251-269.

Rybakowski, J. (2013). Rapid cycling, ultrarapid and ultradian bipolar disorder.Neuropsychiatry and Neuropsychology, 8th(2), 56-54.

Shen H, Zhang L, Xu C, Zhu J, Chen M, & Fang Y (2018). Analysis of the misdiagnosis of a bipolar disorder in the outpatient setting.Psychiatriearchiv Shanghai, 30(2), 93-101. doi: 10.11919/j.issn.1002-0829.217080. PMID: 29736129; PMC-ID: PMC5936046.

Stiles, BM, Fish, AF, Vandermause, R, & Malik, AM (2018). The pressing and ongoing problem of bipolar disorder masquerading as major depressive disorder: an integrative review.Journal of the American Association of Psychiatric Nurses, 24(5), 415–425.

Swann A, Lafer B, Perugi G, Frye M, Bauer M, Bahk W, Scott J, Ha K & Suppes T (2013). Mixed bipolar states: Report of a working group of the International Society for Bipolar Disorders on symptom structure, disease course and diagnosis. American Journal of Psychiatry,170(1), 31-42.

Valenti , M. , Pacchiarotti , I. , Undurraga , J. , Bonnín , C. M. , Popovic , D. , Goikolea , J. M. , Torrent , C. , Hidalgo-Mazzei , D. , Colom , F. , & Vieta , E. (2006). (2002) (2015). Risk factors for rapid dementia in bipolar depression.Bipolar disorders, 17(5), 549-559.

Vázquez G, Lolich M, Cabrera C, Jokic R, Kolar D, Tondo L, & Baldessarini R (2018). Mixed symptoms in major depressive and bipolar disorder: a systematic review.Journal of Mood Disorders, 225,756-760.

World Health Organization. (2019).International statistical classification of diseases and related health problems(11th ed.).

(Video) Handling the Highs and Lows of Rapid Cycling Bipolar Disorder
(Video) Lamotrigine and Lithium Combination for Treatment of Rapid Cycling Bipolar Disorder


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