Bipolar 1 Rapid Cycling and Mixed States

This post covers information on Bipolar 1 Rapid Cycling and mixed states. I suffer this condition. My symptoms fall under the “Ultradian” end of the second graph. No matter where you fall on any of the graphs below, you should seek professional help.

I hope this article helps give you pertinent information and resources. It can be found at PsychEducation.org. I have posted a link to the original article at the end.

“Rapid Cycling And Mixed States As “Waves”

Introduction

Anxiety, mood, and energy, all waving up and down, sometimes with each other, sometimes one going off without the others: a total mess, right? Not quite. It’s a bit technical but the pictures tell it well, so skim through those and see if you get it.

The three color pictures on this page are from Drs. Dean Mackinnon and Ron Pies used with their permission from their article on “affective instability”.Mackinnon This term means, roughly, unstable mood and energy. People with such instability have big changes in their mood, or energy, or creativity over time. The subject may have easy tearfulness, such as crying over a commercial on TV. They may have extreme episodes of anger, often to a minor event. They can sometimes have inappropriate “mirth” — laughing too loud or too long, or being too giddy or goofy — although isn’t it interesting, that’s not a problem I hear about much!

Drs. Mackinnon and Pies offered a new explanation for this instability, which I have tried to “translate” into three steps below. Their model is quite different from the current diagnostic system for bipolar disorder.

You see, according to the current official rules of diagnosis (the DSM-5), “mixed states” are still very narrowly defined: multiple manic symptoms and multiple depressive symptoms at the same time. Other more subtle combinations don’t count. (If the idea that manic and depressive symptoms can occur together is news to you, better jump back to the main page on diagnosis and return here after that). Similarly, the DSM only recognizes cycles of 4 days or longer. Any shorter doesn’t fit on the map.

But patients do have other combinations of depression and hypomania, or mania — not just the two worst phases together. And they do have cycles shorter than 4 days. The DSM can’t really handle these variations, but the model shown here handles them very well. When I show these pictures to my patients, I often see the “light bulb” go on in their head.

Symptoms vary at different rates

Here the green curve represents the mood, the red curve represents energy, and the black curve represents “intellect” (speed of thought, creativity, ability to connect ideas).

KraepelinWaves (Bipolar Rapid Cycling)
KraepelinWaves (Bipolar Rapid Cycling)

As you can see, if they all go up together — and far enough “up” — this would be what is commonly called a manic or hypomanic episode, as shown at point A on the graph. If they all come down together, far enough, that would be an episode of “major depression”, as shown at point B. But now we can see how “agitated depression” could be part of a bipolar problem, when the energy curve is up while the others are down, as at point D.

Point C represents an unusual combination usually recognized only on inpatient psychiatry units, when a person is agitated yet hardly moves, so-called “manic stupor”. But imagine what a milder version of this would look like: the person would know she needed to get moving, indeed she would be thinking of many things she needed to be doing, and she might really want (in a very powerful way) to be doing them, and yet her body would refuse to go along. She would be lying there on the couch, miserable yet not really depressed, wondering what was wrong with her and why she couldn’t get herself going.

Point B represents another very important combination we, psychiatrists, see commonly: the energy wave is up, but the mood wave is down (in this case, the timing is such that the intellect wave is up too, but not as high as the energy — yet there are many combinations, as you’ll see in a moment). This could be called “dysphoric mania”: energized, as in a usual manic phase, but the mood is very negative.

Now consider the rate at which the different waves vary.

Rapid cycling: 4 per year or 4 per week?

Bipolar disorder is supposed to have phases lasting at least 4 days. Shorter than that, and it doesn’t fit the official model. But the shorter versions are seen so often they have their own names, as shown below.

RateOfCyclingCurves (Bipolar Rapid Cycling)
RateOfCyclingCurves (Bipolar Rapid Cycling)

4 per week? sure: here’s a clear case of cycling every other day. Admittedly, when the “cycles” get so short there are multiple moods in a day, the condition gets hard to distinguish from “normal emotions” — normal reactions to events that last a few minutes or even close to an hour or so. If such rapid emotional shifts are extreme, most psychiatrists start to think of a different diagnosis: borderline personality disorder. But here’s the point: combine the first two graphs to see how mixed states explain the experience, next.

Continuous, continually varying symptoms

Many people with Bipolar II do not have the “well intervals”, in between periods of having symptoms, that are often spoken of in websites and books about Bipolar I. This leaves them somewhat puzzled. Do they really have “bipolar disorder?” Why, they never really have “episodes”, let alone “manic” episodes.

Yet as the following graph shows, a rapid cycling of the individual symptoms, at different rates, can create a varying pattern of nearly continuous symptoms. Instead of having identifiable “episodes”, this person has almost constantly shifting symptom phases that blend into one another.

KraepelinMixed (Bipolar Rapid Cycling)
KraepelinMixed (Bipolar Rapid Cycling)

 

**You can find this article in its entirety by clicking the following link:

Rapid Cycling And Mixed States As “Waves”

My sincerest thanks to Mr. Jim Phelps, the author of this article, for his willingness in allowing me to share this information with you. His website has a great deal of useful information. I urge you to visit. 

 Bipolar 1 Rapid cycling, the bane of my existence

Mental illness has been the bane of my existence. Admitted to a psychiatric unit for the second time, when I was 30 years old. A blessing, if can believe that. While there, the doctor diagnosed me with Bipolar 1 Disorder. Mental, emotional, and physical illness. Having been a major cause of many failed relationships, lost jobs, lost friends, and near loss of a life. My life, due to repeated episodes of chronic depression. Many of my diagnoses fall below Bipolar 1 Disorder. Suffering from the effects of this disorder my entire life hasn’t been easy. The illness has made my life difficult, at best.

There are help and hope
Image Description: Bottom left corner has some greenery. Above the greenery is rust colored rocky land which reaches halfway across the photo. The right side of the photo shows two tall cylindrical rust colored rocks reaching upward toward a blue sky shaded with clouds. Atop the rock in the center of the photo is a person wearing a black shirt or pack and white shirt with arm outstretched toward the sky. In the sky behind that rock and toward the left at the horizon is a cluster of bright white clouds that spread out and fade out into the sky in all directions.
“Hope is being able to see that there is light despite all of the darkness.” Desmond Tutu

I urge you to seek help if you feel you have this or any other psychological disorder. Mental illness is just that–an illness. It is treatable. Please do not be ashamed of having a mental illness. There are therapists, psychiatrists, medications, and much more that can help improve your life.

My other blog post, Brains, and disorders, and me, oh my…, covers many mental disorders, along with helpful resources. I have a link to my email on the right sidebar. If you would like to email me personally, please feel free. I AM NOT A PROFESSIONAL. However, I can give you the resources I have at hand that I have utilized. I am also happy and willing to do any research you might need help with.

Bonny J