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Rapid Cycling


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Hi everyone,

I've seen that many people here have put "rapid cycling" in their dx. Now I know what the DSM and Wikipedia definitions are, but I'm wondering what it means to you personally. I've been diagnosed as MDD, but I'm wondering if I might be bipolar II. What causes me to question this is because I'm currently titrating up on Lamictal (lomatrigine), and I've been experiencing some weird mood swings. Currently I'm at 250 mg which is actually 125 mg because I also take carbamazepine which halves the blood level of lomatrigine.

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I've taken that combo less the ADs. It was good to me.

It is common for people to have a rocky time of it starting Lamictal. I wouldn't judge your illness by those few months. I would expect things to start leveling out around 300-350mg. IIRC, Tegretol decreases Lamictal by roughly 40%, so it's not quite half strength. That's an estimate. Actual experience varies.

When I was rapid cycling, it was every 10 days to two weeks and off to the next mood state. Sequence was always the same. All went like clockwork. It sucked mightily. That lasted a couple years varying in intensity. Before, I cycled maybe once a year. After, maybe three or four. Now I am stable. No particularly notable swing in over a year.

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I've taken that combo less the ADs. It was good to me.

It is common for people to have a rocky time of it starting Lamictal. I wouldn't judge your illness by those few months. I would expect things to start leveling out around 300-350mg. IIRC, Tegretol decreases Lamictal by roughly 40%, so it's not quite half strength. That's an estimate. Actual experience varies.

When I was rapid cycling, it was every 10 days to two weeks and off to the next mood state. Sequence was always the same. All went like clockwork. It sucked mightily. That lasted a couple years varying in intensity. Before, I cycled maybe once a year. After, maybe three or four. Now I am stable. No particularly notable swing in over a year.

Thanks Stacia for the quick reply. I'm glad to hear that you are stable. Yeah, every 10 days to two weeks sounds more like the DSM definition. What I notice with Lamictal is more like every 10 minutes literally. I can feel bad for about 10 minutes and suddenly feel great, and vice versa.

About the combo - I know that I like the risperidone and the carbamazepine. I think I am beginning to feel the effects of Lamictal. But I have no idea what the ADs do other than make the pdoc happy.

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I thought rapid was more than 4 episodes per year? technically speaking....

I'd say that I have to agree with Stacia regarding the lamictal titration. If you are starting any med, it's going to impact your mood, and the ultra slow start of lamictal often results in significant swings, so you can't judge your condition by that.

Anna

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Well for me, my rapid cycling has been at least four mood episodes a year, but I have normal periods in between. I feel like, to me, it doesn't seem like a rapid cycle since I get some breaks with normality, but I was told by my psychiatrist it would be considered rapid cycling. So for me, I reckon it could be different from what others consider rapid cycling, I just take what my psychiatrist says and go with it since I trust her.

Isn't the DSM's definition four+ in a year, for rapid cycling, though? I'm unsure what you mean by "that sounds more like the DSM definition," is there somewhere you are seeing something different than I see? I found the DSM online I believe but it says the same thing, is there a link you can share?

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I thought I was rapid cycling by the minute, but really it was a mixed state, which is both mood extremes at the same time, not sequential. Or as I like to call it, hell on earth. I also had rapid cycling in that I would go in and out of extreme moods vs. normal within months of each other. It was a micro/macro thing.

I use lamictal, and I really didn't feel steady "normal" until 200mgs. And I'm not on anything else that would decrease efficacy. Also it took a few weeks at the optimum level to even stable out there. It's a slow climb to the plateau.

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DSM definition for rapid cycling is four or more cycles per year. Humanoid describes the norm for rapid cycling. Cycling in weeks is unusual. Cycling in days often is not bipolar.

Really? I didn't know this. What is it considered to be? My dad treated almost all the patients in Pittsburgh that were cycling daily as bipolar, although even he would admit he had trouble controlling it well. People got better, but were still pretty sick. (I don't know how to write that question without sounding snippy, I genuinely am curious.)

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Interesting debate here as to WTF "rapid cycling" means.

One person just said that if you cycle too rapidly, you're not bipolar.

I know people (with other diagnoses) whose moods just go everywhere, often many times a day, so-called "ultradian cycling" (my mom had the issue, tamed by escitalopram now, but not entirely gone). I used to have the problem before Lamictal (now my mood tends to be mellow-to-lazy, with a few reactive periods when necessary).

My mom's cycles usually go upwards into a hypomanic-like state, which she describes more as an anxiety attack (her technical dx is GAD), although to the casual observer her behavior seems classic hypomania. Although my mood issues are largely in remission, I am prone to a cycle when faced with a major trigger (esp. rejection issues or anything that mimics what gave me PTSD). Usually I'm able to get ahold of myself (I suppose I have the meds to thank) and the cycle ends within a week or so, or when the situation ends. I suppose that's echoing some degree of "normalcy" in my mood. Heh.

Moral of the story? Might want to look for triggers (meds, psychosocial situations, etc.) and avoid them. I don't know how your future with Lamictal will be since you've just started, and starting that med and ramping up on it is rough business, and honestly, my advice is to not give up on it yet. If you're up to a stabilized higher dose of Lamictal and feel yourself cycling rapidly, then the med was likely a bad idea and tapering should be discussed with the pdoc as an option.

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i used to have about 3 depressive and 2 manic or mixed episodes per year. they were connected to seasons. they were no less than one month and no more than three months in duration. i had no normal or euthymic episodes in between. now a lot of it is much better controlled with medication and i cycle about twice a year.

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heh, ultra-rapid cycling means you're not bipolar huh? Guess all those doctors have been wrong all these years and I'm on the wrong meds...

Before I got my moods under control I would cycle every few months until I reached the point where it was ultra-rapid cycling - every few days, sometimes every few hours - then it would hit crisis mode and things would be calm again until the cycle started over. I've never had a depression or a mania last more than six months - at the longest - generally they last about two, maybe three. *shrug* I don't really keep track. I tried, it didn't work.

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Ultra rapid cycling can be triggered by med changes and definitely can happen with Lamictal. I had very rapid cycling (every 12-36 hours) while titrating up on Lamictal, which was the first time I had ever experienced cycling like that. My usual cycling pattern is more like weeks to months, with my shortest episodes being 4-5 days and longest being 18 months.

Edited to add: My worst cycling on Lamictal was between 75-100mg, and it leveled out at 150mg. So your experience doesn't sound very different from mine, accounting for the effect of carbamazepine.

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