[ultramar]

There seem to be a lot of rapid (and/or ultra-rapid) cyclers on this board, and I was wondering if anyone else goes into episodes only about twice a year. They are long (meaning several weeks) and horrific and turn my life upside down, nasty 'hangover' periods, mostly due to med tapering, but I do have long periods in between of basically being 'myself' --with my anxiety and 'issues' but largely manageable (especially with the help of therapy). But a couple of times a year... I've really been feeling alone in this. Can anyone relate?

[Otter63]

Actually I've been told (by my pdoc) that what you describe is the more typical experience. I had episodes (manic for a few weeks then depressed) every 5 yrs, had a stretch of ten years of "normal" then went back to the every 5 yrs. deal until 2010. At that point I found myself having a manic one year after the last. That's when I decided it was time to stay on meds. I've been without a hospitalization since 2011 so I'm hoping I can keep it that way.

[polesapart]

I'm the same as you. I have long episodes (weeks to months), but long periods of stability in between. Because of this I find it hard to gauge whether my meds are working. I'm currently doing well, but whether it's because the meds help, or it's just because I'm in one of my normal periods of stability, who knows!

[Anika.]

I use to have about 3-4 a year. Each would last months, probably fell more on the manic/psychosis side. But when I would get hit with depression it was usually more mixed, so high energy, lack of sleep, physical aggitation. I can't say I had long stable periods in between, I seemed to be stable for a month or so and then repeat the cycle all over again. So I can't say far between.

One thing I can say is that I have not really experienced short duration episodes. I would be up and then down but somehow that seemed to just be residue from being so mentally worn out all the time.

Like you describe..long, severe, turn your life upside down. And if I had a lot of psychosis then the recovery would be even greater as my cognition was greatly reduced.

Have not had a manic or depressive episode in long time, maybe year and a half or two. Also have gone off all meds and stayed off at that same time. I have made many changes in my life and so far have managed to keep myself stable. Seems to be working. Actually this is the longest I have been episode free since I was 14... go figure.

My last episode lasted about 5 months, mania turned to mixed at the end. Psychosis present and honestly I never want to be in that position again. Traumatising, ugh no I am not going through that hopefully ever again.

I can see what you mean Ultramar, I guess it is what they refer to as a more classic presentation. I was not classic in the way that my manic experiences were really very enjoyable.. more hell like than fun forsure. Were you diagnosed as one or two? I have noticed over the years that II seem to talk about faster cycles and much much shorter duration than one. Of course that can vary but just an observation.

[Confusedinomicon]

This is just what I suspect;

I find that most describing ultra rapid cycling may have a commorbid anxiety disorder or bpd. I know for a fact that anxiety can cause mood to alter quickly. I also noticed a lot of people are taking prescriptions for anxiety related issues.

[lil_better_everyday]

For the last 8 to 10 years I have no idea because of drinking habits, but in the 10ish months I've been sober I've had one serious hypo episode that lasted about a week, and that came after a month of serious depression. The only time I ever gave serious thought to doing something permanent.

So for the most part I've felt pretty 'normal', but I don't know if that's the new meds, the lack of self medication or just my normal cycle.

Originally Posted by Confusedinomicon

This is just what I suspect;

I find that most describing ultra rapid cycling may have a commorbid anxiety disorder or bpd. I know for a fact that anxiety can cause mood to alter quickly. I also noticed a lot of people are taking prescriptions for anxiety related issues.

I think some of it could be mixed states (not as defined by DSM), and that mood volatility and lability can be mistaken as being rapid cycles between mania and depression.

This page has this to say about mixed states:

"Often, the switch follows circadian factors (eg, going to bed depressed and waking early in the morning in a hypomanic state). In at least one third of people with bipolar disorder, the entire episode is mixed."

That is very similar to how I experience many of my ill days (but not all). I believe I mistook it for being ultra-rapid cycling. Now though, my episodes seem to last weeks, but I often wake up depressed before it switches to hypomania or some bad mix of the two after about an hour. There are no day-to-day triggers that I can see.

[Anika.]

"*I was not classic in the way that my manic experiences were really very enjoyable.." Not..haha screwed that up.

I always thought of bipolar as this..not completely symptom free between episodes. Blips I guess..symptoms still present in small portions. It is a mental illness with regulation components so that could be possible. My pdoc explained it as risidual effects after the episode. I lean towards thinking there is still inner turmoil so yeah it's going to come out.

One thing I guess is most people have more going on affecting the mood than just bipolar. Thought distortions, perspective on life and themselves and others in it, truama and abuse, core beliefs... there is a lot of contributing factors to mood libilty that tend to get overlooked.

[ultramar]

And if I had a lot of psychosis then the recovery would be even greater as my cognition was greatly reduced.

This. I've had two episodes with very serious delusions. But the 'recovery' (not sure what to call it -aftermath, after most of the worst was over) took a long time. In fact, since that first and worst episode of that kind, I have not been able to reduce my Seroquel dose to what it was before that --as if it had permanently affected me somehow.

I had one episode that lasted a couple of months. I (and my therapist) recognized it too late, it took a long time to get it under control (at that time, I was seeing my psychiatrist very infrequently), since then my therapist (and I) are intent on catching these asap to be able to medicate asap, so it hopefully doesn't get to the point of getting so out of control. The rest a few weeks.

I'm diagnosed with Bipolar I. Yes, I think Bipolar II is characterized by more frequent episodes, or at least more frequent depression (I think, not sure).

[ultramar]

Originally Posted by Confusedinomicon

This is just what I suspect;

I find that most describing ultra rapid cycling may have a commorbid anxiety disorder or bpd. I know for a fact that anxiety can cause mood to alter quickly. I also noticed a lot of people are taking prescriptions for anxiety related issues.

I have co-morbid anxiety/ptsd, it can get very severe. But it feels very different. I don't know if this really happens, but I can see how a bout of really bad anxiety can feel like a sort of hypomania. Intense anxiety can actually make you hyper, agitated, talk fast, distracted, etc. --in theory, anyway, I don't usually get all of these, mostly a lot of fear, difficulty leaving the house, etc.

But to what you said, I can see how it may 'seem' like cycles are more frequent, if some of those cycles are actually part and parcel of anxiety and/or BPD. Who knows. I can see how it would be difficult to distinguish between all of this and it seems possible that if you're struggling with all of these things, at one time or another you're dealing with one or the other, so there's always (often) something going on.

[ultramar]

Originally Posted by Anika.

"*I was not classic in the way that my manic experiences were really very enjoyable.." Not..haha screwed that up.

I always thought of bipolar as this..not completely symptom free between episodes. Blips I guess..symptoms still present in small portions. It is a mental illness with regulation components so that could be possible. My pdoc explained it as risidual effects after the episode. I lean towards thinking there is still inner turmoil so yeah it's going to come out.

One thing I guess is most people have more going on affecting the mood than just bipolar. Thought distortions, perspective on life and themselves and others in it, truama and abuse, core beliefs... there is a lot of contributing factors to mood libilty that tend to get overlooked.

This is very wise! I especially like, My pdoc explained it as risidual effects after the episode. It's not something talked about much, but it's important.

[ultramar]

My understanding is that 'mixed episodes' are a possible component of bipolar I, not bipolar II? Strictly speaking, I believe this is what the DSM states, but does anyone know of other sources that talk about mixed states in the context of bipolar II?

I know that I have had some 'depressive feelings' for lack of a better word (intrusive thoughts of sui/death, comes to mind) during hypo/manic episodes. My *feeling* and I'm not sure if and how research bears this out, is that no 'mood' of any kind is entirely *pure.* It just makes sense to me that when one is hypo/manic some other emotions might at some times come into play, and when one is depressed, some agitation, sleeplessness, etc. may come into play, but all within a not-mixed episode.

Even outside of bipolar episodes, I think those who are depressed or anxious may have other emotions/symptoms at the same time, it seems normal to me. I've occasionally checked out the anxiety forum and the depression forum and have seen that they experience a wide variety of symptoms.

In brief, I think it would be very difficult to distinguish between a 'mixed state' and a mood that simple isn't 100% 'pure.'

Again, strictly speaking (i.e. per DSM) a 'mixed episode' is fulfilling the criteria for both a depressive episode and a *manic* (not hypomanic) episode for at least a week. Everyone is different, but that's what 'they' say.

[middlepath]

I normally only have 2 a year (if that): spring or summer hypo/mania rears its head, then fall/winter at some point depression shows up for a visit. The intensity varies greatly. The mania side has toned down over the years whereas the depression has gotten deeper. I usually only suffer a reallly bad depression every 4-5 years. The other times it is only moderate at most. this is all in an unmedicated state.

Recently I have started Lithium in the wake of being on Paxil for a short time. Paxil launched a period of rapid-cycling for me. Now the rapid cycling has gone away and I am back to my normal self (not sure if that is because of the lithium or if I would be "normal" if unmedicated). I am so new to mood stabilizer I just don't have a lot of input about that yet.

I am not sure if I am bipolar 1 or 2. I never asked and pdoc didn't say anything other than bp. Early in my symptomatic years i seemed much more bp1 but there was alcohol involved so i am not sure if that is true or not, now that i am older it mostly seems bp2. i spend far more time depressed than hypo. depression last months on end for me 4-8 weeks when its "easy", and 6+months if it sucks. hypo/mania lasts at most 2 months but turns mixed right at the end usually (not sure if it is DSM mixed or just feels mixed). Again, i am not sure because i don't know if i get mania or just hypo...not sure where that line is entirely.

[Otter63]

Is the line between hypo and manic defined by the presence of delusions and/or psychosis?

Originally Posted by ultramar

My understanding is that 'mixed episodes' are a possible component of bipolar I, not bipolar II? Strictly speaking, I believe this is what the DSM states, but does anyone know of other sources that talk about mixed states in the context of bipolar II?

I know that I have had some 'depressive feelings' for lack of a better word (intrusive thoughts of sui/death, comes to mind) during hypo/manic episodes. My *feeling* and I'm not sure if and how research bears this out, is that no 'mood' of any kind is entirely *pure.* It just makes sense to me that when one is hypo/manic some other emotions might at some times come into play, and when one is depressed, some agitation, sleeplessness, etc. may come into play, but all within a not-mixed episode.

Even outside of bipolar episodes, I think those who are depressed or anxious may have other emotions/symptoms at the same time, it seems normal to me. I've occasionally checked out the anxiety forum and the depression forum and have seen that they experience a wide variety of symptoms.

In brief, I think it would be very difficult to distinguish between a 'mixed state' and a mood that simple isn't 100% 'pure.'

Again, strictly speaking (i.e. per DSM) a 'mixed episode' is fulfilling the criteria for both a depressive episode and a *manic* (not hypomanic) episode for at least a week. Everyone is different, but that's what 'they' say.

That might be so. We don't use the DSM here, so I don't know (we use ICD, which is confusing. Don't actually know what ICD says either, but frankly it's not that important to me). Even so, which I think people here have told you before, there can be mixed states in bipolar II. And they are very bad, even though it's not bipolar I. Most of my episodes are mixed to some degree (yes I am being obnoxiously liberal with my terms), and they are worse than skull-crushing depression, so while I totally understand that you'd like to stay true to the DSM, I'd also like you to know that, yes, there are mixed states in bipolar II (maybe not defined by the DSM), and they suck. I'm not sure how to explain this clearer, but rest assured what I am talking about is not normal moods at all. And yes, I am able to tell the difference.

I might be reading too much into your posts, but you seem to have strong feelings about rapid cycling, mixed states and bipolar II. Is there a reason for why you discuss this all the time even when it doesn't apply to you? Surely you can accept that bipolar is more than what the DSM says, and surely you can accept that people with bipolar II can experience mixed moods even though the DSM says otherwise? I'm really not interested in comparing and figuring out what is worse, who's entitled to call what what, etc. I just want to make it clear that mixed bipolar II is real (and the DSM doesn't trump reality).

Then again, maybe all of this just boils down to us using words differently. And that is OK, right? They don't always mean the same to all of us.

I found this blog after a quick Google search. http://natashatracy.com/bipolar-diso...es-bipolar-ii/. And I'm not sure if that is outdated or not but on the bottom there is a link to some proposed changes in DSM-V regarding mixed states. At any rate I thought it would be relevant to the discussion.

[ultramar]

Originally Posted by Mandrec

That might be so. We don't use the DSM here, so I don't know (we use ICD, which is confusing. Don't actually know what ICD says either, but frankly it's not that important to me). Even so, which I think people here have told you before, there can be mixed states in bipolar II. And they are very bad, even though it's not bipolar I. Most of my episodes are mixed to some degree (yes I am being obnoxiously liberal with my terms), and they are worse than skull-crushing depression, so while I totally understand that you'd like to stay true to the DSM, I'd also like you to know that, yes, there are mixed states in bipolar II (maybe not defined by the DSM), and they suck. I'm not sure how to explain this clearer, but rest assured what I am talking about is not normal moods at all. And yes, I am able to tell the difference.

I might be reading too much into your posts, but you seem to have strong feelings about rapid cycling, mixed states and bipolar II. Is there a reason for why you discuss this all the time even when it doesn't apply to you? Surely you can accept that bipolar is more than what the DSM says, and surely you can accept that people with bipolar II can experience mixed moods even though the DSM says otherwise? I'm really not interested in comparing and figuring out what is worse, who's entitled to call what what, etc. I just want to make it clear that mixed bipolar II is real (and the DSM doesn't trump reality).

Then again, maybe all of this just boils down to us using words differently. And that is OK, right? They don't always mean the same to all of us.

I found this blog after a quick Google search. Mixed Bipolar Disorder – Mixed Mood Episodes in Bipolar 2 | Bipolar Burble Blog | Natasha Tracy. And I'm not sure if that is outdated or not but on the bottom there is a link to some proposed changes in DSM-V regarding mixed states. At any rate I thought it would be relevant to the discussion.

The DSM is very clear on the existence of Bipolar II and I personally do not deny this at all! The difference of opinion, if and when there is one, is if bipolar II constitutes constant (or near-constant) fluctuations of mood.

Re mixed states, I actually went back and read a link, maybe it was yours, and at the beginning it said mixed is only bipolar I, later on both, I think I've read this before as well. I was actually going to reply here on that. You're absolutely right, of course, and I'm sorry I jumped the gun on that one. So, yes, and I get that mixed exists whatever the diagnosis. But regardless of diagnosis, I was just pointing out that although it could be a mixed state (in general), I don't think any mood is 100% pure; there was actually an interesting thread exploring this some time ago. But this doesn't mean that mixed states aren't very very real and horrible. This happened to me once when I tried to lower one of my medications -it was awful.

I also don't personally 'deny' (can't think of a better word), the existence of rapid cycling, at all. Many people have several episodes a year, for example. What tends to baffle me, though, are rapid cycles defined as a constant (minutes, hour, day) roller coaster of emotions/moods. I can see it happening sometimes, absolutely, I just can't wrap my head around an ongoing/continual, long-term, roller coaster pattern in the context of bipolar.

The point of this thread wasn't to denigrate or deny rapid cycling (though my conception of it [not just because of DSM actually, but other things I've read, what psychiatrists have said when I've asked about it] may be different than some) but to see if there are others out there with as relatively infrequent (as represented on this board) episodes as I have. Sometimes I feel alone here, and wanting to know if there was anyone who could identify with how things work for me. As other people do with, 'Does anyone else...'

I think a lot of people here are trying to find some solidarity in how they personally experience things, I was looking for that here. I think, though, me going off on a tangent on this thread confused things -I am sorry for that.

[Anika.]

Peoples perspective of this illness vary a great deal. I think that is why we hear a lot of conflicting info even from psychiatrists. The DSM even can be seen as controversial.

I definatly have some of my own takes on bipolar, heck I actually believe you can pretty much cure yourself of it or close to it.. I also believe without treatment and age it gets worse if you just let it fester. Where most psychiatrists would say that is WILL get worse without treatment. I don't agree with the chemical imbalance theroies as a whole. And I do believe in nueroplacicity.

Many people would disagree with me on a lot of my thoughts about bipolar. And you know thats ok, we all have our own experience, knowledge and perspectives on this. Questioning things is not wrong, it's how we learn which can lead to healing.

I think sometimes people overlook other contributors to frequent and constant mood fluxuation. I believe we overlook many contributing factors to emotional turmoil and mood states. I don't believe it is all simply becasuse chemicals are gone awry and we have no control in the matter.

Sometimes my perspective on bipolar might offend people or put them off. Often it's because my ideas suggest that there is some accountability or responsability, that we have some choices and some control. But I see that is a really good thing because it tells me we can help steer this thing. Others might see that as a negative comment, infering blame which I actually am not about. Blame doesn't need a place.

And my point really is that when someone is questioning things often times they are only looking for knowledge and trying to fiqure things out for themselves. It's usually is not to invalidate another. No one mentioned in this thread which is worse, merely offer ideas on what the frequent and fast mood shifts could be attributed to.

I actually encourage this kind of discussion because it leads us all to better understanding. Maybe someone will have an 'ahh ha!" moment and gain a peice to their puzzle which could improve there situation. I improved my life a great deal from conversations like this here on PC.

"Ahh-ha" momemts are better than " oh ****.. I am screwed" moments I think.

Yeah, I was reading too much into it. Sorry for that, hope it's OK!

[Anika.]

Heh Mandrec we all do that. plus text can be hard to read without tone or facial expression.

[ultramar]

I think sometimes people overlook other contributors to frequent and constant mood fluxuation. I believe we overlook many contributing factors to emotional turmoil and mood states. I don't believe it is all simply becasuse chemicals are gone awry and we have no control in the matter.

I 100% agree with this.

In the spirit of Anika's call for expressing opinions, albeit divergent from what may be other's opinions, this is at least at the moment, my feelings about bipolar disorder (as a disorder, in general).

First of all, I'm of the mind that mental illness in general is due to some sort of combination of brain stuff (chemicals, size of amygdala, communication between different parts of the brain, etc.), environmental influences (parenting, trauma, etc.) and genetics.

Secondly, if we think that this is all about chemicals roiling around our brains over which we have no control, then how is one to take responsibility for one's actions or seek to change them?

I think a fundamental question to think about (I'm not sure there's any good answer) is if one explodes on someone and belittles them (for example) if they have bipolar, is it not their 'fault' and guilt need not apply, and if one does the same thing, but does not have this diagnoses, are they then expected to feel guilty, apologize, and change their behavior?

I do believe people in general, and people with bipolar can get depressed with it not being a 'bipolar depression' due to things going on in life, or even how one is thinking and interpreting things in one's head. I think it is also possible to go through a period of insomnia, to go through a period of elevated energy and productiveness, without it being bipolar. This is one of the reasons why I, personally, think therapy is so important: to make distinctions, in part to get the help and make the changes needed based on what one is really struggling with at any given time. Obviously any of these things can be due to a bipolar episode as well.

I think bipolar is fundamentally a kind of mood dysregulation. People with other diagnoses can suffer from dysregulation, depression, insomnia, elevated energy, racing thoughts, psychosis, etc. So what is unique about bipolar disorder? That's a big question and people will have different answers. The only thing I can think of with regards to bipolar are two things (personal opinion): a constellation/grouping of certain symptoms occurring simultaneously, and the (prolonged) episodic nature of it.

For whatever reason, I don't know if anyone knows why, there are typically what all the literature calls 'normal' periods in between. This means that during these periods (i.e. weeks, months, years) they do not become dysregulated, they are not reactive to daily occurrences in environment and mind/thinking patterns. Which doesn't mean they feel perfectly well all the time or don't have other issues.

It stands to reason that you can be continuously dysregulated and reactive (for a whole *host* of reasons) and still have discrete episodes that are very different from the day to day stuff. But I think distinguishing between these two is extremely important: in one case you may need to increase medication, in these other cases, the treatment is vastly different and can respond to good therapy. I think bipolar episodes can also be helped by therapy.

Just my opinions on the matter.

[Kev's BG]

Originally Posted by ultramar

There seem to be a lot of rapid (and/or ultra-rapid) cyclers on this board, and I was wondering if anyone else goes into episodes only about twice a year. They are long (meaning several weeks) and horrific and turn my life upside down, nasty 'hangover' periods, mostly due to med tapering, but I do have long periods in between of basically being 'myself' --with my anxiety and 'issues' but largely manageable (especially with the help of therapy). But a couple of times a year... I've really been feeling alone in this. Can anyone relate?

I, too, have long periods of what I call "remission". Often I go many months, (once 18 months) without symptoms that result in not being able to work, screw up my entire life, seriously affect my relationships, etc. Not too much hypomania, usually just very, very depressed. Currently, I'm on a leave of absence from work because I just can't manage the everyday responsibilities required of me. Yes, I can definitely relate to your episode calendar, mine's very similar.

[HopeForChange]

Hi Ultrimar,

First post for me, so hi! I also have long periods of "normalcy" between mood episodes. In fact, I haven't been manic since 2010...and the depressions are also discrete, though I will say my mood runs a little low even during "normal" periods.

I have a great psychiatrist who helps me tease apart whether or not a mood is situational (e.g. sadness due to grief, anger due to life circumstances, etc.), and doesn't automatically assume a mood change is due to the bipolar disorder (well, schizoaffective disorder--bipolar type in my case). It's a relief that my psychiatrist is like that because as a result, I don't have a lot of unnecessary med changes.

I, too, am confused about rapid cycling. From what I've read, rapid cycling is officially defined as four or more mood episodes (mania or depression) in a year. However many who are rapid or ultra-rapid cycling seem to have that many mood episodes in a day. I'm not discounting the experiences of those who describe such cycles--it just seems like the medical literature doesn't describe that type of cycling (or its treatment) very well.

Best,
Hope

[ultramar]

I have a great psychiatrist who helps me tease apart whether or not a mood is situational (e.g. sadness due to grief, anger due to life circumstances, etc.), and doesn't automatically assume a mood change is due to the bipolar disorder (well, schizoaffective disorder--bipolar type in my case). It's a relief that my psychiatrist is like that because as a result, I don't have a lot of unnecessary med changes.

This is sooo important --it sounds like you have a great psychiatrist! I think it's a kind of 'skill' for anyone to tease out how they're feeling and why, identify their emotions, but it seems to me that this type of skill -which involves distinguishing between 'episodes' and other moods- when having bipolar disorder makes a huge difference, maybe it's essential.

I think acknowledging that it's not bipolar, in part, involves a certain tolerance for unpleasant emotions --in that a pill is not the answer to make it go away. The treatment is different, the way(s) to resolve it are different. When it's sadness, anger, etc. unrelated to bipolar, I think on the positive side, it can lead to less hopelessness/helplessness, knowing that this isn't something dropping out of the sky, but rather something that can be worked on and changed in the long-term. The downside, or part of it, may be the issue of 'guilt' which I mentioned earlier.

I don't understand rapid cycling either, maybe psychiatrists are diagnosing differently than the intention of the DSM for any number of reasons that I'm clearly not in a position to understand, as I'm not a mental health professional. I'm actually planning on asking my psychiatrist about it next I see him and see what he thinks, he may provide some insight.

[ultramar]

Forgot to say --Welcome HopeforChange!

[HopeForChange]

Ultramar,

Thanks so much for the welcome!

Yes, my psychiatrist is great. I feel so lucky to have her. I feel badly that I felt this way, but at first I thought maybe she didn't care because she wasn't always giving me meds when I felt bad. With time, though, I've come to appreciate that she helps me anyway...even if not by giving a med...and I'm happy not to be over-medicated.

Best,
Hope