(Ultra) Rapid-cycling BP: not a post about spinning.

Run-of-the-mill Bipolar Disorder (BP) is a cycle between usually extreme moods that typically last for a couple of weeks or months and, for the very unfortunate, years. The good news is that BP is totally manageable if treated and the patient adheres to their treatment plan and medication (many don’t – more on that here). But then there’s rapid-cycling bipolar and it’s a shit-show.

[I’m no doctor, what follows here is based on my own experience and opinion. You should not rely on the information contained hereunder without consulting a competent physician]

Now, there’s another subset of BP beyond Type I and Type II – this one is a real roller-coaster: rapid cycling BP. Folk with rapid cycling bipolar disorder, such as the author of this blog, experience moods that typically only last days and, in my case given certain environmental factors, may even present as ultra-rapid cycling bipolar disorder with switching over a matter of hours.

What makes rapid cycling BP so difficult to manage is the unpredictability of when it’ll hit. Generally, if I take my medication as prescribed (again, difficult at the best of times) BP episodes are fairly consistent and predictable. However, in the face of environmental triggers this ‘ultradian rhythm’ is upset and bipolar moods kick in lasting for as little as a few hours or a few days which makes managing and planning to work around the symptoms very difficult.

[Rapid cycling BP is often confused with a mixed episode – these are very different conditions. I’ll cover mixed episodes in a future post]

Mindless fear is greater than mindful fear.

I suspect human physiology tends to need consistent patterns and, almost certainly, routine is key for healthy and happy life. I reckon this is related to the forces of the circadian rhythm, I’ll have to do some more research in that regard though.

A lack of certainty and consistency in ones rhythm of life would set even the most regimental of ‘habit advocates’ off kilter. As a rapid-cyclist one never really knows what’s coming next. Imagine you’re chilling at your PC having a regular work day and at the back of your mind that a darkness is creeping up on you and you’re left asking yourself, “I’m good right now, but in a few hours who knows? I’ll probably be singing Bohemian Rhapsody in the office kitchen.”

These unknowns are hard to deal with and when you’ve responsibilities like work commitments or deadlines the unknowns soon present as anxiety and before you realize it’s happening you’re gripped with fear for what’s to come.

I Have Ultra-Rapid Cycling Bipolar Disorder

Well, that’s not entirely true all of the time, actually. I’ve garden variety BP Type II with rapid cycling but given the right (wrong?) set of circumstances I’ve a tendency to begin the slippery slope into ultra-rapid cycling bipolar.

And when I say rapid, I mean literal hours between the poles. Take my word for it – this is unadulterated hell.

Treating Rapid Cycling Bipolar Disorder

Well, turns out the options here are pretty limited. This is due in part to a research void in the study of this particular variety of BP. Usually clinical trials concern themselves with the prevention of single BP episodes, and preventing recurrence through maintenance treatments.

I can’t say I blame the clinicians and researchers. The very nature of how rapid-cycling presents is a barrier to finding suitable subjects for research: onset is rapid and unpredictable, the duration of the episodes is often so short the patient would barely have completed a consent form before they’re back to their old selves.

The limited research that has been done (for the most part literature reviews and wild conjecture) suggests that rapid-cycling BP sufferers try these coping mechanisms:

1. Identify and eliminating sources of mood destabilization such as substance abuse and erratic sleep patterns (said researcher gives no tips as to how manage ‘sleep patterns, predictably since sleep is a mystery for most BP folk).
   
2. Treating medical comorbidity such as hypothyroidism (and I would assume other aggravating conditions affecting sleep, anxiety etc.).
   
3. Exercising caution when using antidepressants (“caution” being an euphemism for “avoid at all costs”).
   
4. Optimizing treatment with mood stabilizing agents.

Consider an ’emergency kit’ for when the bad moon is rising.

I can totally get behind point four above. For the most part BP I & II sufferers are usually on maintenance treatments and considering that these treatments rely on maintaining a particular concentration of medication in the body, simply adding more of these medicines every time a rapid incident happens doesn’t make sense – a rapid episode requires a fast acting solution.

It’s vital that a rapid-cycler have rapid action mood stabilizers to deal with the immediate effects of a BP episode to curb and hopefully arrest the consequences of full blown episodes every couple of hours (see this post for an account of devastating effects of full blown mania and this post about why mania terrifies me).

So, what medications are useful for arresting a rapid cycle in it’s tracks?

Well, definitely not an antidepressant. Ever. These are known to trigger severe manic episodes in BP patients. Avoid at all costs. I speak from experience.

I find that the anxiety of ‘what-if’ is one of the biggest culprits in triggering a manic episode. I’m still muddling my way through the options here, but for the moment it seems that Alprazolam (Xanax), Clobazam (Urbanol) and Clonazepam (Rivotril here in SA, Klonopin in Trump-land) are good options – so basically some variant of a Benzodiazepine. Note that these are temporary fixes and should be avoided for long term use ’cause dependency.

Some other medication rapid-cyclers might like to have in their ’emergency kit’ might also include an anti-psychotic (of the immediate release variety) such as Quetiapine (Seroquel), Aripiprazole (Abilify) or Olanzapine (Zyprexa).

How I Live with Rapid Cycling Bipolar Disorder.

My go to phrase applies here: “this too shall pass”. Knowing that the nature of BP is that moods come and go is a source of hope for me and many others. Unlike, for example, those with Major Depressive Disorder us BP folk know there’s an end to whatever cycle we’re in.

It’s important however to acknowledge that you’re experiencing an episode, rapid-cycling or no. Of course, many times we realize too late that were having an episode at all, but if at all possible learn to see the signs of impending lunacy and respond accordingly.

• If it isn’t etched into your mind already: take your fucking medication. Always.
  
• Speak to your physician about an ’emergency kit’ of medication that you can take before the shit hits the fan.
  
• Consider regulating your sleep patterns with prescription medication and take it as prescribed.

And vitally important in all of this is that if you find yourself experiencing extreme and unabated moods and inappropriate behavior or suicidal ideations call your doctor immediately or get yourself to Emergency Care.

Is there any hope rapid cycling will ‘get better’?

Probably not, sorry.

Given time and knowing thyself will help you manage the condition and will work wonders to improve your day to day life and functioning.

So I hear. This could be a vicious rumor.

I also recommend everyone, not just those with BP, research and critically assess evidence based peer-reviewed research regarding their illness both to learn and to assist you to explain factually to others what BP is all about to help end the stigma and ignorance of mental illnesses.