[ultramar]

I'm not very familiar with rapid (and ultra-rapid) cycling bipolar disorder, so I did some research (National Institute of Health):
Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period.
According to the DSM-IV diagnostic criteria, symptoms must last at least 4 days to merit the diagnosis of a hypomanic episode.
But clearly, from what I've seen here, some people experience changes more than 4 times a year (criteria for rapid cycling). So is this ultra-rapid cycling? I'm finding things here and there about it on the Internet, but not really much in terms of detailed descriptions.

It's confusing too because (per above) the DSM cites a cut-off of a minimum of 4 days for hypomania, but this would not seem to apply to ultra-rapid cycling.

So those of you who suffer with rapid or ultra rapid: what is your experience like? Do you not have much relief between cycles as they occur so often? Since in occurs so frequently, how hard is it to tell the difference between a new cycle and a 'non-bipolar' mood (i.e. triggered by something in the environment)? How were you diagnosed? It seems to me that this is more complicated in some ways than the 'traditional' bipolar 1 or 2.

Can you share your experiences?

Thanks.

[Anneinside]

What you should look into is mixed episodes, having depressive and (hypo)manic symptoms at the same or closely adjacent times. Sometimes what people call ultra-rapid cycling is actually mixed episodes.

[ultramar]

Originally Posted by Anneinside

What you should look into is mixed episodes, having depressive and (hypo)manic symptoms at the same or closely adjacent times. Sometimes what people call ultra-rapid cycling is actually mixed episodes.

But if you're having them at the same time, then would you soon change to a different mood (i.e. pure hypomanic or depression) soon after? But this makes a lot of sense, thanks.

[~Christina]

Yes what Anne said.
I use to think I was rapid cycling all the time. But working with my T, it turns out I was in mixed episodes. It was hellish! I'm sure one day it will return, but I have learned tons of coping skills, I'm pretty sure it will help.

[Anika.]

I had what they deem rapid cycling. I would be manic for a few months straight then depressed for months then back to manic for months. There was seldom any relief or stability in mood in between. On par for 4 or more a year but they lasted months so same as defined for the other criteria.

I too find it confusing when it comes to ultraidian or ultra rapid and the criteria for mania and hypo, I think the criteria for mania is more than a week or 10 days..something close. It does get confusing. I know at least for myslef mania takes a little days to get off the ground, more like I would get hypo first and within a week full blown mania would follow. But everyone experiences it quite differently.

I agree with Anne and Christina that mixed episodes might be more likely.

[Anika.]

Originally Posted by ultramar

But if you're having them at the same time, then would you soon change to a different mood (i.e. pure hypomanic or depression) soon after? But this makes a lot of sense, thanks.

I've had a lot of mixed episodes but they did not change to a different mood quickly. For me a mixed mood would last months as well. But mixed moods are very confusing and I can see the confusion of trying to determine which end is up. A lot of people in mixed states experience a lot of agitation both mental and physical which could also contribute to confusion, hard to think at all in that state.

[jesusplay]

since ultra rapid isn't in the DSM-IV or the upcoming DSM-5 is it even really bipolar?

The 4 days duration in the DSM is only there for practical reasons (it's a cutoff), not actually because it has much true diagnostic value, which is also why you can be diagnosed with bipolar without fitting the four-day criteria if your symptoms fit with ultra-rapid or ultradian. Duration is not really as relevant as that (you have to think of the duration in it's proper context, I think especially it should be compared with the intensity of the symptoms and to what degree the moods are reactions to something that could normally elicit a similar mood), but they maintain that it is still practical in trying to figure out what the best course of therapy is. "They" are the DSM people, and their decision to keep the cutoff duration is controversial. There is, I know, some controversy around the ultra-rapid and ultradian categories of bipolar, but as far as I know it's not one of the most controversial issues (ultradian is more controversial, but very rare). Almost everyone agrees that these people are bipolar, and the controversy is more about how they should be labelled. If the DSM is getting rid of the ultra-rapid label they will surely give these people another label, and that label surely is not BPD (or anything else non-bipolar). There are also some prominent people who hypothesize that BPD is in fact a bipolar spectrum illness. The heritability and the genes involved with BPD and bipolar are comparable, the suicide rate is very high for BPD but not as high as bipolar. The prognosis is worse for people who have rapid cycling (that means their illness is probably more severe than yours). I don't think questioning their bipolarity is very constructive.

how hard is it to tell the difference between a new cycle and a 'non-bipolar' mood

It can be hard for me sometimes to recognize that hypomania is hypomania, but after an hour or two I usually have it figured out. When I come down it is very obvious. My normal moods that are reactions to something are nothing like my short-lived hypomania, but I consistently underestimate the severity of my hypomanic symptoms, at least for a while until I can look back and see how I've been and what I've done. So while I have difficulties figuring out what is a symptom of hypomania and what is not, I do not confuse normal moods with hypomania. I've never had a normal mood that is anything like my hypomania is nowadays. The depressed state is easy for me to recognize, but I score very high on tests for depression so I don't know if it's the same for other people.

I thought I was an ultra-rapid cycler, now I think I'm in a mixed state. I've had almost no unmedicated relief for two years or something like that. I've had six months of medicated relief, i.e. sleep, drowsiness and dullness.

[faerie_moon_x]

I am an ultradian cycler. (Thry googling ultradian cycler instead of ultra-rapid, which is more like a slang term.) I also am mixed a lot. I'm at a point I can't tell where I am more than half the time. Up and down together or cycling? I often can't tell exactly where. But, I know when I'm more up vs. more down. I will say "more manic" or "more depressed." Because, I'm usually both but one often out-weighs the other. But those cycle, too, and my cycles last about 3-5 days for each.

I have "stable" days, but those are few and far between. Usually it will be one day only.

As an example... last week I hit a ban day where I cycled all day, due to some triggers. That was Tuesday the 9th, so that put me more manic. Okay, so all last week and over the weekend I was more manic until Wednesday. Well, that one was great and it was helping me get through this huge project at work until the stress knocked it out. It's pulled what I call the cloud on my head. My thoughts are racing but I'm really feeling low and completely overwhelmed. But now the weekend is coming and that usually helps relieve my stress so possibly by MOnday I'll be out of it again.

[Anika.]

Originally Posted by Mandrec

The prognosis is worse for people who have rapid cycling (that means their illness is probably more severe than yours). I don't think questioning their bipolarity is very constructive.

.

I don't see where anyone questioned their bipolarity here. Can we meassure severity? Isn't that in the eye of the beholder?

[faerie_moon_x]

I agree wtih Anika, we can't measure severity, because we're all different and handle things differently. It's like people who try to say type 1 diabetes is worse than type 2, based off the fact that people with type 1 require insulin from the start. But really, it's all relative to how you take care of yourself vs. which dx you have.

Originally Posted by Anika.

I don't see where anyone questioned their bipolarity here. Can we meassure severity? Isn't that in the eye of the beholder?

I was referring to the controversy around those labels, which goes beyond just the scientific discussions. I wasn't thinking about anyone in this thread or on this forum (that I can remember anyway). Sorry for being unclear.
No I don't think we can easily measure severity of illness, although I'm sure it can be operationalized. What I mean is that since we know that the prognosis is worse, we can probably assume that the illness is also more severe. It's not a direct causal relationship at all, but my common sense says prognosis and severity are very much correlated.

[ultramar]

The prognosis is worse for people who have rapid cycling (that means their illness is probably more severe than yours). I don't think questioning their bipolarity is very constructive.

For the record, I'm not questioning the bipolarity of ultra rapid cycling, just had questions about it -nor comparing which are more 'severe.' Maybe you were referring to someone else, though.

On another note, of course there will be different clinicians and lay people with different opinions, I don't think rapid cycling is part of a BPD spectrum or vice versa. I think in the strictest sense, the changes in mood is something they have in common, but I think for the most part, the similarities end there. But what this means, regardless, is that you can suffer from both, as distinct issues. Many people with bipolar disorder have other diagnoses/issues they have to contend with -it just sucks all around.