How Rapidly Can Bipolar Mood Swings Occur?
Bipolar disorder is, by definition, a condition in which mood states alternate. The length of time that patients spend in each state is variable, but individual patterns can often be determined, and understanding the patterns can help in selecting a treatment protocol. The mood states of bipolar disorder include mania, hypomania, depression and euthymia.
Bipolar Mood States
Mania is a mood state that is abnormally elevated. It may include insomnia, elation, irritability, inflated self-esteem, distractibility, increased activity and energy, rapid speech, poor judgment and lack of social and emotional restraint. Hallucinations, psychosis and paranoia may also occur.
Hypomania is a less intense form of mania. Patients experiencing hypomania rarely need to be hospitalized and may be able to continue to work or carry on other normal activities. Hypomania does not involve psychosis.
The depression of bipolar disorder is similar to unipolar depression in its symptoms. It may include persistent sadness and a loss of interest in activities that once brought pleasure. People may have changes in sleeping patterns and eating habits. They may also have difficulty concentrating, low energy, feelings of guilt or worthlessness and thoughts of death. Major depression is diagnosed when patients have five or more symptoms and minor depression when a smaller number of symptoms are present.
Euthymia is a normal, positive, non-depressed mood. When patients are stable and experiencing neither mania nor depression, they can be said to be euthymic. Euthymia may not mean an absence of all symptoms. Clinicians may define patients as euthymic when their scores are below a predetermined level on the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD).
Types of Bipolar Disorder
Variations of bipolar disorder include the following:
- Bipolar I – Bipolar I disorder is diagnosed when patients experience severe episodes of both mania and depression. The National Institute of Mental Health (NIMH) notes that for a bipolar 1 diagnosis, manic episodes should last at least seven days or be so severe that the patient needs hospital care. Depressive symptoms typically last at least two weeks. A typical pattern is for bipolar patients to experience one or two cycles of mania and depression a year. Manic episodes often occur in the spring.
A 2010 article in the Archives of General Psychiatry reported on a study of bipolar I patients which determined that the median duration of mood episodes was 13 weeks. The study also found that more than 75 percent of patients recovered from mood episodes within 1 year. The exceptions tended to be patients whose episodes began with psychosis or severe psychosocial impairment or those who had been ill for a longer period of time. Patients tended to recover from mania, hypomania or minor depression more quickly than from major depression.
- Bipolar II – Patients who experience bipolar II disorder have periods of severe depression but experience hypomania rather than full manic episodes. For diagnosis, periods of hypomania must last at least 4 days. Patients typically have more intense and frequent depressive episodes than hypomanic ones and may also have more frequent depressive episodes than patients diagnosed with bipolar I disorder.
- Cyclothymic disorder – The mood swings of cyclothymic disorder are not as severe and tend to last for shorter periods of time than those of bipolar I or bipolar II. Patients who experience alternating episodes of hypomania and mild depression for at least two years and who do not meet the diagnostic criteria for another type of bipolar disorder may receive this diagnosis.
- Mixed episode – Mixed episode or mixed feature bipolar disorder occurs when patients simultaneously experience symptoms of varying mood states. People may feel hopeless or depressed but also have high energy and racing thoughts.
- Rapid cycling – Cycling is the term for moving through alternating mood states. Patients with rapid-cycling bipolar disorder experience four or more distinct mood episodes in a year. The NIMH notes that rapid cycling appears to be more common in patients who experience their first bipolar episode at an early age often during the mid to late teen years. The medical website WebMD notes that the pattern occurs in about 10 to 20 percent of bipolar patients and is more common among women and those with bipolar II disorder. WebMD also notes that the pattern can occur at any point in the course of the disease and can change with treatment.
- Ultra-rapid cycling – Ultra-rapid cycling occurs when moods last only days or weeks.
- Ultradian cycling – A 2013 article on the website Healthline notes that a small subset of bipolar patients have alternating mood states that may last only hours. The article notes that the condition is clinically acknowledged but not listed in the Diagnostic and Statistical Manual of Mental Disorders. The article further notes that such rapidly alternating states can be difficult to distinguish from natural emotions but that in some cases, the swings are dramatic enough to make it clear that they are major mood episodes. Children with bipolar disorder may be the most likely to experience ultradian cycling.
Bipolar Disorder Treatment Considerations
Bipolar disorder is a condition that warrants careful monitoring because the medications that treat one mood state may trigger another. There is concern, for instance, that typical antidepressants can trigger mania in some bipolar patients. Some medications, such as benzodiazepine drugs, may be useful in select situations, such as for severe mania, but because patients can develop dependence and should be tapered off the medication gradually, they are not suitable for patients with rapid cycling.
Like other mental health conditions, bipolar illness often co-exists with substance addiction to drugs like clonazepam. If you or a loved one is struggling with addiction, we can help you find treatment. Our toll-free helpline is staffed 24 hours a day, and we can answer your questions including checking your insurance coverage for you if you wish at no cost or obligation. Call now, and begin your journey of recovery.