[HunnyBunny5]

Hi all,

I’ve been reading and my BP II is very much with rapid cycling, however after reading some posts on here I’m trying to understand some stuff. Are mixed and rapid cycling both same just different names or something totally different?

Thank you

[Katme]

They are technically different. Mixed episodes aka dysphoric mania.

Rapid cycling has the same episodes - mania and depression- just they cycle much faster.

But for me it gets blurry. I know for a fact that my episodes cycle in 2 weeks. So if it feels like im rapid cycling, then Im probably in a mixed state. Bc my mixed episodes look either like classic dysphoric mania or very rapid mood changes (sad to happy to angry)

[luvyrself]

Originally Posted by HunnyBunny5

Hi all,

I’ve been reading and my BP II is very much with rapid cycling, however after reading some posts on here I’m trying to understand some stuff. Are mixed and rapid cycling both same just different names or something totally different?

Thank you

—-you can have mixed episodes with or without rapid cycling. I experience both, the variable is stress and how I handle the mixed episodes with coping techniques and medication tweaking. Hugs!

[Movingon69]

Do the happen in the same day or day 1 then day 2 for rapid cycling? I assumed I have been rapid cycyling but your description of blurring the lines makes me wonder.

[Nammu]

Mixed is a TYPE or classification of BP. Bipolar depressed, bipolar manic, bipolar mixed

Rapid cycling is Frequency, how many episodes a year. 4 or more episodes a year is rapid cycling. Going up and down in hours or days is most often a personality thing. An episode by definition last 2 weeks or longer

[Movingon69]

Originally Posted by HunnyBunny5

Hi all,

I’ve been reading and my BP II is very much with rapid cycling, however after reading some posts on here I’m trying to understand some stuff. Are mixed and rapid cycling both same just different names or something totally different?

Thank you

I'm sorry you are dealing with this. Hope it gets better soon. Like you, I'm trying to understand this. I'm newly dx. Hope you don't mind me asking an additional question on your thread.

If you were to ask Emil Kraepelin, a German psychiatrist, in the late 1800s/early 1900s about his observations of mixed episodes, he would describe possible mood combinations of anxious mania, mania with poverty of thought, inhibited mania, manic stupor, excited depression, and depression with flight of ideas (1). If you looked in the current Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) used in the US today, you would rather see a primary bipolar episode being experienced (depression, hypomania, or mania) with the specifier "with mixed features" added if it was what was more commonly called a "mixed episode" in earlier DSM editions. The primary episode is the mood state where most symptoms are represented, but some symptoms of another mood state also exist.

According to the DSM-5, one cannot have a mixed state of hypomania with also full manic features. If any full manic features appear in a given episode, I believe it is automatically a manic episode. However, one can certainly have more manic symptoms than depressed symptoms, and vice versa. I believe (but am not 100% sure) that if one mood state (i.e. depression or mania) has especially severe symptoms, that mood state may be considered the primary mood state, even if there are more symptoms of the other mood state, but they are are milder than the worst symptom of the other state.

When I have experienced mixed states (mixed features) in the past, mine were generally the classic type where I did have some depressive symptoms simultaneously as manic symptoms. Consider the labels Emil Kraepelin described, such as excited depression. Excitement or high energy levels are usually associated with mania, but one can be severely depressed with high energy levels. I have always considered mixed states to be particularly dangerous for me, considering the "mix" of depressive and manic symptoms I often had.

General "rapid cycling" is defined as having 4 or more bipolar episodes per year. This can mean that you could potentially be purely depressed for one whole month (meeting depression criteria), stable 2 weeks, hypomanic with mixed features for 6 weeks (meeting criteria), stable for 2 months, developing a full blown mania for 5 weeks (meeting criteria), and depressed for 3 months, then stable for the rest of the months. That equals 4 episodes.

"With rapid cycling" in the DSM-5 is a specifier, like "with mixed features". In the DSM-5, the terms "ultra rapid cycling" (several pure episodes within week/month) and "ultra ultra rapid cycling" (several pure episodes within 24 hours) are not used. That obviously doesn't mean that these types of mood events don't happen. It's my assumption (I'm not sure) that such episodes are simply given the "with rapid cycling" specifier.

I have definitely heard of people call rapid-type cycling "mixed episodes". I believe many psychiatrists have/will call such events mixed episodes at times, too, but they are different than the mixed features I described where episodes of depression and hypomania/mania are experienced simultaneously. But simultaneous in my book is not 4 hours of pure depression and then 6 hours of pure hypomania.

I definitely know that my episodes have often started "pure" and then turned "mixed" or totally switched on a dime to the opposite mood "pole". I definitely see that as rapid cycling. The only thing that is unclear to me is what one calls a three-day period where you are purely depressed one day, wake up hypomanic the next day, become depressed the third day, and then become stable. Is that rapid cycling? I'd have to ask my psychiatrist. I don't know. I do know that one psychologist I spoke with told me that she calls such situations "mood lability", where minimum episode length is not met.

The minimum length requirement for hypomania is 4 consecutive days, according to the DSM-5. The minimum length of a manic episode is 1 week, or if it's so severe that it results in hospitalization. The minimum length of a depressive episode is a 2 week period, according to the DSM-5. So again, how would a doctor label a three-day wild mood bonanza? Well, I guess if it resulted in hospitalization from full blown manic symptoms, it would be a manic episode. But what if it was only three days and there were pure depressive hours and pure hypomanic hours without hospitalization? Is that just mood lability? And what about only three days where there were simultaneous depressive and hypomanic or manic symptoms? Is that considered an episode? Or again, just mood lability, unless you are hospitalized for the manic symptoms?

This is very confusing! I think a lot of psychiatrists are not thrilled with the DSM-5 completely. I think some psychiatrists are not so picky about minimum episode lengths. That's just my guess.

Resources (sorry not in APA format):

Surviving Manic Depression - A Manual On Bipolar Disorder For Patients, Families, and Providers by E. Fuller Torrey, M.D. and Michael B. Knable, D.O., Copyright year 2002 (pp. 38-40)

Diagnostic And Statistical Manual of Mental Disorders - Fifth Edition by American Psychiatric Association, Copyright year 2013 (pp. 123-127, 149-151)

Anything in RED font represents my own questions or uncertainties.

[luvyrself]

In the book you mentioned, Surviving..., do they have a large section on mixed or only p38-40? I will order it if it has a large section on mixed. I just received a very technical book entirely about mixed states, rapid cycling and atypical forms of bipolar. This was written by pdocs for pdocs. It is heavy going but I’m glad to have it. Haven’t plowed thru the section on treatment yet. I’m still in pursuit of finding the right mix of meds for me. I have been stable for long periods of time.
I most adamantly do not agree that very rapid cycling is due to personality. To me that is like saying that alcoholism is due to personality. Did you mean ability to apply coping skills? Yes, that is hugely important.
I think the DSM has great limitations but they have to have something Like that. Think of it as a work in progress.
Thanks so much for this discussion. I no longer feel like I am wandering so alone in the wilderness of mixed episodes. So glad people are starting to discuss this. Message me, friend me, great!

For me mixed episodes are being manic and depressed at the same time, pretty much depression but faster and angrier whereas ultra ultra rapid cycling (switching between mania and depression within the same day or every day) I have distinct periods (as short as a few hours) of the euphoria of mania or the dullness of depression, although when cycling that quickly it does look and sometimes feel like a mixed episode.

[HunnyBunny5]

Wow thank you! This has been so helpful. I have been “diagnosed “ bipolar II for about 5 years but no so many I know still look at it taboo that learning about it can be hard at times. I am seen through the Veteran Affairs so sometimes my dra seem to stick to basics lol. I am definitely a ultra ultra ultra rapid cycling person. I can have various moods in one day with it being everywhere. Some days are great but others a so wonky I can’t think straight. I also believe from the descriptions I diminutively have mixed as well. Mine is considered more on the manic side than the mania side most times but not so serious to be bipolar I according to my dr.

[Wild Coyote]

I don't think I have had a chance to welcome you.

Welcome to PC!
I hope you find the information and the support you may be seeking.
Please do make yourself at home. I hope to see you around the forums.


WC

Originally Posted by luvyrself

In the book you mentioned, Surviving..., do they have a large section on mixed or only p38-40? I will order it if it has a large section on mixed. I just received a very technical book entirely about mixed states, rapid cycling and atypical forms of bipolar. This was written by pdocs for pdocs. It is heavy going but I’m glad to have it. Haven’t plowed thru the section on treatment yet. I’m still in pursuit of finding the right mix of meds for me. I have been stable for long periods of time.
I most adamantly do not agree that very rapid cycling is due to personality. To me that is like saying that alcoholism is due to personality. Did you mean ability to apply coping skills? Yes, that is hugely important.
I think the DSM has great limitations but they have to have something Like that. Think of it as a work in progress.
Thanks so much for this discussion. I no longer feel like I am wandering so alone in the wilderness of mixed episodes. So glad people are starting to discuss this. Message me, friend me, great!

The Surviving Manic Depression book I mentioned mostly presents mixed states from pages 38-40, but does mention other things about it on various other pages. I recommend this book, but it is very outdated in some respects. I really wish Dr. E. Fuller Torrey would update it. If you look it up on Amazon, you can look at some of the pages by clicking the book cover image "Look Inside". A nice aspect of this book is that it gives a history, some stats, good descriptions of the illness, some written descriptions from people who have it of what their episodes are like (incl. from Kay Redfield Jamison), risk factors, theories on causes, treatments, special issues (BP in children, addiction/abuse, med non-compliance, homelessness, arrests, suicide, sex issues, mania seduction). It also talks about BP and creativity, answers commonly asked questions (Should I tell people? Will I pass it on to children? How does it affect family members?). Issues for advocates are also included.

I never said rapid cycling has anything to do with personality. I hope you didn't think I did. Is it the "mood lability" term that makes you think that? "Mood lability" is a term often used for Borderline PD, but it is also used for mood disorders, and doesn't imply that they are in the same axis. I have read that on occasion mood lability can confuse doctors as to whether it is Borderline Personality Disorder type or mood disorder type, but there are many other symptoms and criteria that should be able to clearly provide a differentiation between the two, though I know some people happen to have both.

I am a true believer in the bipolar spectrum. My psychiatrist has told me several times in the past, that people with bipolar disorder do not all have the same "flavor", and even within the same bipolar type. Our courses are all unique, the stories are far from being the same.

[Movingon69]

Originally Posted by BirdDancer

If you were to ask Emil Kraepelin, a German psychiatrist, in the late 1800s/early 1900s about his observations of mixed episodes, he would describe possible mood combinations of anxious mania, mania with poverty of thought, inhibited mania, manic stupor, excited depression, and depression with flight of ideas (1). If you looked in the current Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) used in the US today, you would rather see a primary bipolar episode being experienced (depression, hypomania, or mania) with the specifier "with mixed features" added if it was what was more commonly called a "mixed episode" in earlier DSM editions. The primary episode is the mood state where most symptoms are represented, but some symptoms of another mood state also exist.

According to the DSM-5, one cannot have a mixed state of hypomania with also full manic features. If any full manic features appear in a given episode, I believe it is automatically a manic episode. However, one can certainly have more manic symptoms than depressed symptoms, and vice versa. I believe (but am not 100% sure) that if one mood state (i.e. depression or mania) has especially severe symptoms, that mood state may be considered the primary mood state, even if there are more symptoms of the other mood state, but they are are milder than the worst symptom of the other state.

When I have experienced mixed states (mixed features) in the past, mine were generally the classic type where I did have some depressive symptoms simultaneously as manic symptoms. Consider the labels Emil Kraepelin described, such as excited depression. Excitement or high energy levels are usually associated with mania, but one can be severely depressed with high energy levels. I have always considered mixed states to be particularly dangerous for me, considering the "mix" of depressive and manic symptoms I often had.

General "rapid cycling" is defined as having 4 or more bipolar episodes per year. This can mean that you could potentially be purely depressed for one whole month (meeting depression criteria), stable 2 weeks, hypomanic with mixed features for 6 weeks (meeting criteria), stable for 2 months, developing a full blown mania for 5 weeks (meeting criteria), and depressed for 3 months, then stable for the rest of the months. That equals 4 episodes.

"With rapid cycling" in the DSM-5 is a specifier, like "with mixed features". In the DSM-5, the terms "ultra rapid cycling" (several pure episodes within week/month) and "ultra ultra rapid cycling" (several pure episodes within 24 hours) are not used. That obviously doesn't mean that these types of mood events don't happen. It's my assumption (I'm not sure) that such episodes are simply given the "with rapid cycling" specifier.

I have definitely heard of people call rapid-type cycling "mixed episodes". I believe many psychiatrists have/will call such events mixed episodes at times, too, but they are different than the mixed features I described where episodes of depression and hypomania/mania are experienced simultaneously. But simultaneous in my book is not 4 hours of pure depression and then 6 hours of pure hypomania.

I definitely know that my episodes have often started "pure" and then turned "mixed" or totally switched on a dime to the opposite mood "pole". I definitely see that as rapid cycling. The only thing that is unclear to me is what one calls a three-day period where you are purely depressed one day, wake up hypomanic the next day, become depressed the third day, and then become stable. Is that rapid cycling? I'd have to ask my psychiatrist. I don't know. I do know that one psychologist I spoke with told me that she calls such situations "mood lability", where minimum episode length is not met.

The minimum length requirement for hypomania is 4 consecutive days, according to the DSM-5. The minimum length of a manic episode is 1 week, or if it's so severe that it results in hospitalization. The minimum length of a depressive episode is a 2 week period, according to the DSM-5. So again, how would a doctor label a three-day wild mood bonanza? Well, I guess if it resulted in hospitalization from full blown manic symptoms, it would be a manic episode. But what if it was only three days and there were pure depressive hours and pure hypomanic hours without hospitalization? Is that just mood lability? And what about only three days where there were simultaneous depressive and hypomanic or manic symptoms? Is that considered an episode? Or again, just mood lability, unless you are hospitalized for the manic symptoms?

This is very confusing! I think a lot of psychiatrists are not thrilled with the DSM-5 completely. I think some psychiatrists are not so picky about minimum episode lengths. That's just my guess.

Resources (sorry not in APA format):

Surviving Manic Depression - A Manual On Bipolar Disorder For Patients, Families, and Providers by E. Fuller Torrey, M.D. and Michael B. Knable, D.O., Copyright year 2002 (pp. 38-40)

Diagnostic And Statistical Manual of Mental Disorders - Fifth Edition by American Psychiatric Association, Copyright year 2013 (pp. 123-127, 149-151)

Anything in RED font represents my own questions or uncertainties.

Thanks! This helped me a lot. Is there a minimum days of feeling the mix like in depression and mania since it is different in the pure form state? Based on your response I've been mixed and not rapid cycling.

Movingon69, please do discuss this with your psychiatrist to get the best answer. Either way, I know such experiences are rough. As you saw by all of my red font content, I have plenty of questions and confusion, too. I just thought I'd share what I did learn. I know it helps me to come up with questions. I'm not sure if all psychiatrists know all answers. Sometimes my psychiatrist is honest when he's not sure of things.

[luvyrself]

Originally Posted by spikes

For me mixed episodes are being manic and depressed at the same time, pretty much depression but faster and angrier whereas ultra ultra rapid cycling (switching between mania and depression within the same day or every day) I have distinct periods (as short as a few hours) of the euphoria of mania or the dullness of depression, although when cycling that quickly it does look and sometimes feel like a mixed episode.

——rapid cycling IS a mixed episode. I am so glad we are having these discussions about mixed because I think a lot of bipolars have mixed episodes. This type of bipolar is less understood, but if we talk it up on forums and w ts and pdocs, progress will be made. They will know better how to medicate it etc.

[luvyrself]

Originally Posted by BirdDancer

The Surviving Manic Depression book I mentioned mostly presents mixed states from pages 38-40, but does mention other things about it on various other pages. I recommend this book, but it is very outdated in some respects. I really wish Dr. E. Fuller Torrey would update it. If you look it up on Amazon, you can look at some of the pages by clicking the book cover image "Look Inside". A nice aspect of this book is that it gives a history, some stats, good descriptions of the illness, some written descriptions from people who have it of what their episodes are like (incl. from Kay Redfield Jamison), risk factors, theories on causes, treatments, special issues (BP in children, addiction/abuse, med non-compliance, homelessness, arrests, suicide, sex issues, mania seduction). It also talks about BP and creativity, answers commonly asked questions (Should I tell people? Will I pass it on to children? How does it affect family members?). Issues for advocates are also included.

I never said rapid cycling has anything to do with personality. I hope you didn't
think I did. Is it the "mood lability" term that makes you think that? "Mood lability" is a term often used for Borderline PD, but it is also used for mood disorders, and doesn't imply that they are in the same axis. I have read that on occasion mood lability can confuse doctors as to whether it is Borderline Personality Disorder type or mood disorder type, but there are many other symptoms and criteria that should be able to clearly provide a differentiation between the two, though I know some people happen to have both.

I am a true believer in the bipolar spectrum. My psychiatrist has told me several times in the past, that people with bipolar disorder do not all have the same "flavor", and even within the same bipolar type. Our courses are all unique, the stories are far from being the same.

—-no, I believe it was someone else who made the reference to personality.
Thanks so much for your detailed interest in the subject of mixed episodes. As a patient I am researching mixed states and they really don’t understand it very well.
I friended you and would love to speak to speak to you by telephone because the topic is so complex. I am still learning how to private message and leave my phone number.

People can rapid cycle with no mixed episodes. Are you referring to ultra or ultra rapid cycling?

I had a year where I had rapid cycling (4 or more episodes in a year period). One or two episodes were pure depression, one a pure manic, and maybe two or three where they started pure manic and ended mixed (simultaneously depressed and manic). They were all separated by periods of stability or threshold stability.

[luvyrself]

Originally Posted by BirdDancer

People can rapid cycle with no mixed episodes. Are you referring to ultra or ultra rapid cycling?

I had a year where I had rapid cycling (4 or more episodes in a year period). One or two episodes were pure depression, one a pure manic, and maybe two or three where they started pure manic and ended mixed (simultaneously depressed and manic). They were all separated by periods of stability or threshold stability.

—I see what you mean. I don’t want semantics to get in the way here. I am using the word semantics because I don’twant to define everything by the DSM. Why? They have to try to label things but I am so skeptical of the entire psychiatric profession with its ridiculous 15 minute office visits at this point that I am loath to buy into a system that fails on so many levels.

[MoodyMountain]

I've had a weeks long mixed episode, but my hypomanic/manic episodes are short (hours) since starting medication and they frequently start during larger depressions. I clearly hd BPI but now I look more like bipolar NOS due to meds.

Originally Posted by luvyrself

—I see what you mean. I don’t want semantics to get in the way here. I am using the word semantics because I don’twant to define everything by the DSM. Why? They have to try to label things but I am so skeptical of the entire psychiatric profession with its ridiculous 15 minute office visits at this point that I am loath to buy into a system that fails on so many levels.

I'm sorry you've had such bad experiences with members of the psychiatric profession.

I contacted a well-known psychiatrist named Dr. Jim Phelps asking for his view on some of the things discussed here. He was kind enough to respond very quickly. If interested in it, see Perspectives on: Mixed Episodes vs. Ultradian Cycling and Mood Lability in BP and BPD

[Pookyl]

Ever since I’ve had bipolar I’ve experienced both mixed mood as well as rapid cycling.

[FearLess47]

This topic is so incredibly helpful, thank you for discussing it. I have been trying to "figure out" for myself WTH I am experiencing. I suspect I've been misdiagnosed for a long time, partly due to my previous desire to hide and pretend everything was fine, but then also due to not having a "language" that I could talk about this stuff with professionals.

These definitions have clarified for me that, in the discussion of bipolar 2, I have constant ping ponging mixed episodes that are UBER (ultra ultra wouldn't even cover it! ) rapid. Daily, during the day, sometimes for longer periods.

However...it has recently become clear that I may be dealing with Dissociative Identity Disorder (co-morbid or not, remains to be discovered)...which, for me, explains so much more about why/how I "switch" from different moods so quickly and distinctly.

Becoming "aware" of this DID probability seems to have almost "kicked up" the ping ponging...so it is all quite confusing. My new psych is changing up my meds a little, I have a new trauma therapist who will help me with the dissociation, and I have several concurrent major medical issues requiring medication and hospital sedation and procedures...so there is a hot mess up in here.

But I am very grateful to get some understanding of the variances....number one, to see it is OK that I don't fit neatly into a box. And number two...to give me some words I can start putting to what until now has felt like a jumbled mess in a dryer one day and an articulate strong leader in the next. Agh!

Thanks for being here...

FearLess47

[HALLIEBETH87]

I’m currently mixed and miserable and so is everyone around me I imagine!

I talked to my t bc I thought I was either rapid cycling or mixed and he said mixed.

[Gabyunbound]

There have been some great replies here and a lot of useful information.

I have to agree with Nammu, that very very short mood changes are likely the product a personality disorder, specifically -usually- BPD, and not Bipolar Disorder.

BP requires a persistent mood, lasting at least one week (I can't remember exactly how long, but that, or more). There are, and I think they are few and far between, pdocs who believe in ultra rapid cycling, but I cannot concur.

Mood changes within hours and within a given day, I think, are often triggered by one's environment, even if it's not recognized by the sufferer as such. This is an indication of BPD, but even more so, if those triggers are related to how one relates to other people/relationships with others.

This might not be a popular opinion, but it's what I believe. The DSM indicates this, and even if you're skeptical of the DSM, to me it just makes sense. Pdocs need to take the time with patients to determine their patterns of relating to others and if 'mood swings' correspond to this kind of relating (fear of abandonment, etc.). Patients, also, need to have the insight (often through therapy) to see these patterns for what they are and try to eliminate them. I'm not criticizing anyone for lack of insight, but I think that it can potentially take many years to figure out how one is relating to others, and how one's mood changes according to how one relates to others.