Is your shopping out of control? Find yourself covering up your spending? For some people who are depressed, it is not uncommon for compulsive buying — in stores or on the Internet — to serve as a distraction or self-esteem booster. But “retail therapy” is a short-lived high because it doesn’t address underlying depression. Also be aware that shopping sprees could also be a sign of mania, in bipolar disorder.

Drinking Heavily

Nearly a third of people with major depression abuse alcohol.  If you feel that you need to drink to cope with anxiety and depression, you may be one of them.  Although a drink may seem like it provides a lift when you’re down, alcohol is a depressant, so overdoing it can make depression episodes worse and more frequent.

Forgetfulness

Depression may be one reason for feeling foggy or forgetful. Studies show that prolonged depression or stress can raise the body’s levels of cortisol. This can shrink or weaken the part of the brain associated with memory and learning. Depression-linked memory loss seems to be worse for older people. The good news: Treating depression may also improve depression-related memory problems.

Excessive Internet Use

Prefer virtual social interactions to real-life ones? Spending excessive amounts of time on the Internet? It may be a sign of depression. Studies have shown a link between high levels of depression and excessive Internet use. People who overuse the Internet tend to spend their time on pornography, online community, and game sites.

Binge Eating and Obesity

A 2010 study from the University of Alabama found that young adults who report being depressed tended to gain weight more around their waist — a risk for heart disease. Other studies have linked depression with binge eating, particularly in middle-age people. Treating depression can help treat these problems.

Shoplifting

About a third of shoplifters suffer from depression. For some people who feel powerless and insignificant from depression, shoplifting provides feelings of power and importance.  It can also provide a rush to counter depression “numbness.” For people who shoplift because they are depressed, these feelings are more important than the item they are stealing.

Back Pain

Got a backache that won’t quit? Studies show that depression may be a risk factor for chronic lower back pain. One study showed that up to 42% of people with chronic lower back pain experienced depression before their back pain started. Yet depression can often go ignored or undiagnosed because people don’t associate it with aches and pains. By the same token, having chronic pain puts you at risk for depression.

Risky Sexual Behavior

Depression is more commonly associated with lost libido than with an increased interest in sex. But some people use sex to cope with depression or stress. Increased promiscuity, infidelity, sexual obsession, and high-risk behavior such as unsafe sex can all be signs of depression. It can also reflect problems with impulse control or be a sign of mania in bipolar disorder. And they can have serious, negative effects on health and in your personal life.

Exaggerated Emotions

Often people who are depressed show little emotional expression. Other times, they show too much. They can be suddenly irritable or explosive. They may express exaggerated feelings of sadness, hopelessness, worry, or fear. The key is a sudden change in behavior. If a person who is usually flat with their feelings becomes hyperemotional, depression may be the cause.

Problem Gambling

Gambling can make you feel excited and revved up. But if you gamble more than recreationally, you may be depressed or you may suffer from a gambling addiction disorder. Problem gamblers are much more likely than others to be depressed and abuse alcohol. Many say they were anxious and depressed before they started gambling. No matter how much of a quick rush gambling causes, it won’t provide the big payoff — relief from depression.

Smoking

Having trouble quitting smoking? Being depressed doubles your risk of smoking. Heavy smoking – more than a pack a day – and having a cigarette within 5 minutes of waking are common habits among smokers who are depressed, according to the CDC. While depressed smokers are less likely to quit, they can. Quitting programs that use techniques similar to those used to treat depression, such as cognitive-behavioral therapy or antidepressant medications, seem to help.

Not Taking Care of Yourself

What does fastening your seatbelt have to do with depression? Suddenly neglecting basic self-care can be a sign of depression and low self-esteem. The signs may be as small as not buckling up or brushing your teeth or as big as skipping physical exams or not tending to chronic conditions such as heart disease or diabetes. Get help for your depression and you’ll likely begin to take care of yourself again.

WEB MD

Provided by http://www.mentalhealthsupportcommunity.com

 

Definition

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

• Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
• Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
• Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
• Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.

Signs and Symptoms

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.

People having a manic episode may:	People having a depressive episode may:
Feel very “up,” “high,” or elated Have a lot of energy Have increased activity levels Feel “jumpy” or “wired” Have trouble sleeping Become more active than usual Talk really fast about a lot of different things Be agitated, irritable, or “touchy” Feel like their thoughts are going very fast Think they can do a lot of things at once Do risky things, like spend a lot of money or have reckless sex	Feel very sad, down, empty, or hopeless Have very little energy Have decreased activity levels Have trouble sleeping, they may sleep too little or too much Feel like they can’t enjoy anything Feel worried and empty Have trouble concentrating Forget things a lot Eat too much or too little Feel tired or “slowed down” Think about death or suicide

Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.

Diagnosis

Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. Talking with a doctor or other licensed mental health professional is the first step for anyone who thinks he or she may have bipolar disorder. The doctor can complete a physical exam to rule out other conditions. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation or provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.

Note for Health Care Providers: People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to ensure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania. They may, however, experience some manic symptoms at the same time, which is also known as major depressive disorder with mixed features.

Bipolar Disorder and Other Illnesses

Some bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make a diagnosis. In addition, many people have bipolar disorder along with another illness such as anxiety disorder, substance abuse, or an eating disorder. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.

Psychosis: Sometimes, a person with severe episodes of mania or depression also has psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:

• Someone having psychotic symptoms during a manic episode may believe she is famous, has a lot of money, or has special powers.
• Someone having psychotic symptoms during a depressive episode may believe he is ruined and penniless, or that he has committed a crime.

As a result, people with bipolar disorder who also have psychotic symptoms are sometimes misdiagnosed with schizophrenia.

Anxiety and ADHD: Anxiety disorders and attention-deficit hyperactivity disorder (ADHD) are often diagnosed among people with bipolar disorder.

Substance Abuse: People with bipolar disorder may also misuse alcohol or drugs, have relationship problems, or perform poorly in school or at work. Family, friends and people experiencing symptoms may not recognize these problems as signs of a major mental illness such as bipolar disorder.

Risk Factors

Scientists are studying the possible causes of bipolar disorder. Most agree that there is no single cause. Instead, it is likely that many factors contribute to the illness or increase risk.

Brain Structure and Functioning: Some studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. Learning more about these differences, along with new information from genetic studies, helps scientists better understand bipolar disorder and predict which types of treatment will work most effectively.

Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder than others. But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that even if one twin develops bipolar disorder, the other twin does not always develop the disorder, despite the fact that identical twins share all of the same genes.

Family History: Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of the disorder. However, it is important to note that most people with a family history of bipolar disorder will not develop the illness.

Treatments and Therapies

Treatment helps many people—even those with the most severe forms of bipolar disorder—gain better control of their mood swings and other bipolar symptoms. An effective treatment plan usually includes a combination of medication and psychotherapy (also called “talk therapy”). Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment helps to control these symptoms.

Medications

Different types of medications can help control symptoms of bipolar disorder. An individual may need to try several different medications before finding ones that work best.

Medications generally used to treat bipolar disorder include:

• Mood stabilizers
• Atypical antipsychotics
• Antidepressants

Anyone taking a medication should:

• Talk with a doctor or a pharmacist to understand the risks and benefits of the medication
• Report any concerns about side effects to a doctor right away. The doctor may need to change the dose or try a different medication.
• Avoid stopping a medication without talking to a doctor first. Suddenly stopping a medication may lead to “rebound” or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
• Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch  or by phone at 1-800-332-1088. Clients and doctors may send reports.

For basic information about medications, visit the NIMH Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website .

Psychotherapy

When done in combination with medication, psychotherapy (also called “talk therapy”) can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

• Cognitive behavioral therapy (CBT)
• Family-focused therapy
• Interpersonal and social rhythm therapy
• Psychoeducation

Visit the NIMH Psychotherapies webpage to learn about the various types of psychotherapies.

Other Treatment Options

Electroconvulsive Therapy (ECT): ECT can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments. Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make taking medications too risky. ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. People with bipolar disorder should discuss possible benefits and risks of ECT with a qualified health professional.

Sleep Medications: People with bipolar disorder who have trouble sleeping usually find that treatment is helpful. However, if sleeplessness does not improve, a doctor may suggest a change in medications. If the problem continues, the doctor may prescribe sedatives or other sleep medications.

Supplements: Not much research has been conducted on herbal or natural supplements and how they may affect bipolar disorder.

It is important for a doctor to know about all prescription drugs, over-the-counter medications, and supplements a client is taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a client and doctor work closely together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help clients and doctors track and treat bipolar disorder most effectively.

Finding Treatment

• A family doctor is a good resource and can be the first stop in searching for help.
• For general information on mental health and to find local treatment services, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357).
• The SAMHSA website has a Behavioral Health Treatment Services Locator  that can search for treatment information by address, city, or ZIP code.
• Visit the NIMH’s Help for Mental Illnesses webpage for more information and resources.

For Immediate Help

If You Are in Crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.

If you are thinking about harming yourself or thinking about suicide:

• Tell someone who can help right away
• Call your licensed mental health professional if you are already working with one
• Call your doctor
• Go to the nearest hospital emergency department

If a loved one is considering suicide:

• Do not leave him or her alone
• Try to get your loved one to seek immediate help from a doctor or the nearest hospital emergency room, or call 911
• Remove access to firearms or other potential tools for suicide, including medications

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including bipolar disorder. During clinical trials, treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Please Note: Decisions about whether to participate in a clinical trial, and which ones are best suited for a given individual, are best made in collaboration with your licensed health professional.

How Do I Find Clinical Trials at NIMH/NIH?

Scientists at NIMH study many subjects including cognition, genetics, epidemiology, and psychiatry. The studies take place at the National Institutes of Health (NIH) Clinical Center in Bethesda, Maryland, and require regular visits. After the initial phone interview, participants come to an appointment at the clinic and meet with a clinician. Visit Join a Study: Bipolar Disorder – Adults or Join a Study: Bipolar Disorder – Children for more information.

How Do I Find a Clinical Trial Near Me?

To find a clinical trial anywhere in the world, visit ClinicalTrials.gov . This is a searchable database of federally and privately supported clinical trials conducted in the United States and around the globe. ClinicalTrials.gov has information about a trial’s purpose, who may participate, locations, and phone numbers for more details. Anyone interested in joining a clinical trial should consult a health professional before making a commitment.

Learn More

Free Booklets and Brochures

• Bipolar Disorder: A brochure on bipolar disorderthat offers basic information on signs and symptoms, treatment, and finding help. Also available en Español.
• Bipolar Disorder in Children and Teens: A brochure on bipolar disorder in children and teens that offers basic information on signs and symptoms, treatment, and finding help. Also available en Español.

Research and Clinical Trials

• Antipsychotic Medicines for Treating Schizophrenia and Bipolar Disorder – A Review of the Research for Adults and Caregivers:  This summary talks about one type of medicine—antipsychotics—used to treat schizophrenia and bipolar disorder.
• Bipolar Disorder Statistics – Adults: This webpage provides information on trends in prevalence of and use of treatments/services by adults with bipolar disorder.
• Bipolar Disorder Statistics – Children: This webpage provides information on trends in prevalence of and use of treatments/services by children with bipolar disorder.
• Join a Study: Bipolar Disorder – Adults: This webpage lists NIMH bipolar disorder clinical trials that are recruiting adults.
• Join a Study: Bipolar Disorder – Children: This webpage lists NIMH bipolar disorder clinical trials that are recruiting children.

Last Revised: April 2016

Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of the NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.

Rapid Cycling and its Treatment

What is bipolar disorder?

Bipolar disorder, also known as manic depression, is a treatable illness involving extreme changes in mood, thought, energy, and behavior. A person with bipolar disorder has moods that usually alternate between mania, or extremely “up” mood, and depression, or extremely “down” mood. This change or “mood swing” can last for hours, days, weeks, or even months. Typically, someone with bipolar disorder experiences one or two cycles a year, with manic episodes generally occurring in the spring or fall.

Manic episode

A distinct period of elevated, enthusiastic or irritable mood lasting at least one week (or less than one week if hospitalization is required), that includes at least three of the following symptoms:

• Increased physical and mental activity and energy
• Exaggerated optimism and self-confidence
• Excessive irritability, aggressive behavior
• Decreased need for sleep without becoming tired
• Grandiose thoughts, extreme sense of self-importance
• Racing speech, racing thoughts, impulsiveness, poor judgment
• Reckless behavior such as spending sprees, impulsive business decisions, erratic driving and sexual indiscretions
• In severe cases, delusions and hallucinations

Hypomanic episode

Similar to a manic episode, except that it is less severe and there are no delusions or hallucinations. It is clearly different from an individual’s non-depressed mood with a clear change in activity and attitude, an d v isible behavior that is unusual or out-of-character.

Major depressive episode

A period of two weeks or more during which five or more of the following symptoms are present:

• Prolonged sadness or unexplained crying spells
• Significant changes in appetite and sleep patterns
• Irritability, anger, worry, agitation, anxiety
• Pessimism, indifference
• Loss of energy, persistent exhaustion
• Unexplained aches and pains
• Feelings of guilt, worthlessness and/or hopelessness
• Inability to concentrate; indecisiveness
• Inability to take pleasure in former interests; social withdrawal
• Excessive consumption of alcohol or use of chemical substances
• Recurring thoughts of death or suicide

Mixed state (also called mixed mania):

A period during which symptoms of a manic and a depressive episode are present at the same time. People who experience mixed states describe feeling activated and “revved up,” but also full of anguish and despair. Rapid, pressured speech can co-exist with impulsive, out-of-control thoughts of suicide and self-destruction or aggression. Hopelessness, irritability, uncontrollable swings between racing thoughts and a feeling of “being in blackness” can all happen over the course of minutes.

Who gets bipolar disorder?

Bipolar disorder affects more than two and a half million adult Americans during any given year. The illness usually begins during a person’s late teen years, although it can sometimes start in early childhood or as late as a person’s 40s or 50s. An equal number of men and women develop this illness, and it affects people of all races, ethnic groups and social classes.

What causes bipolar disorder?

The exact cause of bipolar disorder is not known. We do know that it is a brain-based medical illness and that certain structures of the brain related to emotions, behavior, and thinking are affected. Bipolar disorder may be related to an imbalance in certain chemicals in the brain, called neurotransmitters. There is a genetic component, meaning the illness runs in families, although genetics does not completely predict who will develop bipolar disorder and who will not.

Are there different types of bipolar disorder?

Physicians and researchers agree there are several kinds of bipolar disorder. Most people who have the illness experience episodes of mania and periods of depression, but the length, frequency, and pattern of these highs and lows vary. Sometimes individuals with bipolar disorder experience frequent mixed states. Some of the different combinations of symptoms may not be medically significant, while others are important enough to be classified as specific types of bipolar disorder that may be treated in very different ways. For more information, see DBSA’s brochure, Guide to Depression and Manic Depression.

What is rapid cycling?

Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. With rapid cycling, mood swings can quickly go from low to high and back again, and occur over periods of a few days and sometimes even hours. The person feels like he or she is on a roller coaster, with mood and energy changes that are out-of control and disabling. In some individuals, rapid cycling is characterized by severe irritability, anger, impulsivity, and uncontrollable outbursts. While the term “rapid cycling” may make it sound as if the episodes occur in regular cycles, episodes actually often follow a random pattern. Some patients with rapid cycling appear to experience true manic, mild manic, or depressive episodes that last only for a day. If there are four mood episodes within a month, it is called ultra-rapid cycling, and when several mood switches occur within a day, on several days during one week, it is called ultra-ultra-rapid, or ultradian cycling. Typically, however, someone who experiences such short mood swings has longer episodes as well. Some individuals experience rapid cycling at the beginning of their illness, but for the majority, rapid cycling begins gradually. Most individuals with bipolar disorder, in fact, experience shorter and more frequent episodes over time if their illness is not adequately treated. For most people, rapid cycling is a temporary occurrence. They may experience rapid cycling for a time, then return to a pattern of longer, less frequent episodes, or, in the best case, return to a stabilized mood with the help of treatment. A small number of individuals continue in a rapid cycling pattern indefinitely.

Who develops rapid cycling?

As many as half of all people with bipolar disorder may develop rapid cycling at some time during their illness. While there are no absolute rules about who will develop this pattern, women may be more likely to do so, even though bipolar disorder is equally common in both genders. Use of certain antidepressants to treat bipolar disorder can bring on or worsen rapid cycling. Often, the cycling decreases when the antidepressant medication is stopped. However, when stopping an antidepressant, a person should be aware of the possibility of depressive episodes re-occuring, work closely with a doctor to find a more effective medication combination, and never stop taking a medication or change a dosage without first talking with a doctor about it. There may also be a link between rapid cycling and drug or alcohol abuse. A history of substance abuse may make an individual more likely to have rapid cycling. Studies also show that substance abuse is more common in families of people with rapid cycling than in families of people with bipolar disorder who do not have rapid cycling. It is not known whether this is the result of a genetic link between substance abuse and rapid cycling, or if it is evidence of “self-medication” among people with rapid cycling.

What causes rapid cycling?

The basic cause of rapid cycling remains unknown, but three overlapping theories exist:

Kindling (Sensitization):

According to the “kindling” theory, early episodes are triggered by actual or anticipated life events such as the death of a loved one or an upcoming job interview. Over time, the person with the illness becomes increasingly sensitive to more minor “triggers” or stressors, and becomes more likely to have an episode in response to these events. Eventually the person may begin to have episodes without any “triggers.” Episodes become increasingly frequent and the end result of this process, when the illness is not properly treated, may be rapid, ultra-rapid or ultradian cycling.

Biological rhythm disturbances:

This theory proposes that people with rapid cycling have daily biological rhythms that are out of sync with typical “time-giving” events such as dawn and dusk. This theory could account for the sleep disturbances typical of mania and depression and explain other symptoms as well. If biological rhythms are important, a link between rapid cycling and seasonal affective disorder (SAD) may be suggested. It is also possible that abnormal daily biological rhythms do not cause the illness itself but do contribute to the length and seriousness of a manic or depressive episode. For example, if insomnia is treated early and aggressively, mild or moderate symptoms can be prevented from snowballing into a severe and destructive episode.

Hypothyroidism:

This theory proposes that rapid cycling is due to inadequate amounts of thyroid hormone in the brain. Most people with rapid cycling do have adequate levels of thyroid hormone in the blood, but they may respond well to treatment with thyroid hormone regardless of their initial blood levels.

Are there effective treatments for rapid cycling?

Yes, although it can be challenging to find the right treatment. People with bipolar disorder shouldn’t give up hope if the first few medications or medication combinations prescribed are not successful. There are many different treatment options to try. Keep a good record of what has worked, has not worked, or has partially worked to help your doctor with future medication choices for you. For more information about medications for bipolar disorder, read DBSA’s Brochure, Finding Peace of Mind: Medication and Treatment Strategies for Bipolar Disorder. Be sure to talk to your doctor before adding any medication—including prescriptions, natural/herbal supplements and over-the-counter remedies—to your treatment.

Psychotherapy can be an important part of your treatment plan. Not only are people with bipolar disorder at risk for further manic or depressive episodes, it’s possible to experience difficulty as a result of past episodes. Characteristics such as irritability, tendency to cry, racing thoughts or impulsiveness may cause social problems. Because people with bipolar disorder are often unfairly judged, they may lose opportunities to develop friendships or romantic involvement, or have trouble achieving their career goals. These struggles may contribute to self-esteem problems. That’s why it’s helpful for people with bipolar disorder to consult their physicians or mental health professionals about one-on-one counseling and/or the benefits of couples, family, or group therapy. Discussing sticking to a treatment plan that works and managing and preventing suicidal thoughts can prove to be lifesaving.

Charting your moods can help you and your doctor identify patterns and things that cause stress, track your improvement on different medications or get an idea of when new episodes might occur. DBSA offers the Personal Calendar as a mood-tracking tool. This calendar has a place for you to record the medication you take each day, changes in your mood level, stressful life events, side effects and other symptoms.

Helping yourself, helping others: The value of local DBSA support groups

No one with bipolar disorder (rapid cycling or any other type) needs to feel alone or ashamed. With a grassroots network of nearly 1,000 support groups, DBSA offers an opportunity for people to meet and share coping skills, support and inspiration with others who understand. Each group has a professional advisor and an appointed facilitator. Members are people with depression or bipolar disorder and their family members. When combined with a treatment plan, DBSA support groups: Can help you stick with your treatment plan and may help you avoid hospitalization. Provide a place for mutual acceptance, understanding and self-discovery. Help you understand that a mood disorder does not define who you are. Give you the opportunity to benefit from the experiences of those who have “been there.” Take the next step toward wellness for yourself or someone you love. Call DBSA at (800) 826-3632 to find the DBSA chapter or support group nearest you, or click here. If there is no group in your area, DBSA can help you start one.

Conclusion

Research suggests that rapid cycling differs from other forms of bipolar disorder. Individuals with these patterns of mood changes may respond differently to standard and experimental treatments than other people with bipolar disorder. With its sudden and unpredictable mood changes, rapid cycling may be more difficult to manage than other types of bipolar disorder. This challenge makes it particularly important for people with this illness to work closely with their physicians and/or mental health professionals to get the best results possible, to stick with the treatment plan they are given, to find support and not to give up hope. As we learn more about the brain, many more treatments will become available. A great deal of progress has been made recently, and more discoveries are expected in the years ahead.

What is bipolar disorder?

Bipolar disorder, also known as manic depression, is a treatable illness involving extreme changes in mood, thought, energy, and behavior. A person with bipolar disorder has moods that usually alternate between mania, or extremely “up” mood, and depression, or extremely “down” mood. This change or “mood swing” can last for hours, days, weeks, or even months. Typically, someone with bipolar disorder experiences one or two cycles a year, with manic episodes generally occurring in the spring or fall.

Manic episode

A distinct period of elevated, enthusiastic or irritable mood lasting at least one week (or less than one week if hospitalization is required), that includes at least three of the following symptoms:

• Increased physical and mental activity and energy
• Exaggerated optimism and self-confidence
• Excessive irritability, aggressive behavior
• Decreased need for sleep without becoming tired
• Grandiose thoughts, extreme sense of self-importance
• Racing speech, racing thoughts, impulsiveness, poor judgment
• Reckless behavior such as spending sprees, impulsive business decisions, erratic driving and sexual indiscretions
• In severe cases, delusions and hallucinations

Hypomanic episode

Similar to a manic episode, except that it is less severe and there are no delusions or hallucinations. It is clearly different from an individual’s non-depressed mood with a clear change in activity and attitude, an d v isible behavior that is unusual or out-of-character.

Major depressive episode

A period of two weeks or more during which five or more of the following symptoms are present:

• Prolonged sadness or unexplained crying spells
• Significant changes in appetite and sleep patterns
• Irritability, anger, worry, agitation, anxiety
• Pessimism, indifference
• Loss of energy, persistent exhaustion
• Unexplained aches and pains
• Feelings of guilt, worthlessness and/or hopelessness
• Inability to concentrate; indecisiveness
• Inability to take pleasure in former interests; social withdrawal
• Excessive consumption of alcohol or use of chemical substances
• Recurring thoughts of death or suicide

Mixed state (also called mixed mania):

A period during which symptoms of a manic and a depressive episode are present at the same time. People who experience mixed states describe feeling activated and “revved up,” but also full of anguish and despair. Rapid, pressured speech can co-exist with impulsive, out-of-control thoughts of suicide and self-destruction or aggression. Hopelessness, irritability, uncontrollable swings between racing thoughts and a feeling of “being in blackness” can all happen over the course of minutes.

Who gets bipolar disorder?

Bipolar disorder affects more than two and a half million adult Americans during any given year. The illness usually begins during a person’s late teen years, although it can sometimes start in early childhood or as late as a person’s 40s or 50s. An equal number of men and women develop this illness, and it affects people of all races, ethnic groups and social classes.

What causes bipolar disorder?

The exact cause of bipolar disorder is not known. We do know that it is a brain-based medical illness and that certain structures of the brain related to emotions, behavior, and thinking are affected. Bipolar disorder may be related to an imbalance in certain chemicals in the brain, called neurotransmitters. There is a genetic component, meaning the illness runs in families, although genetics does not completely predict who will develop bipolar disorder and who will not.

Are there different types of bipolar disorder?

Physicians and researchers agree there are several kinds of bipolar disorder. Most people who have the illness experience episodes of mania and periods of depression, but the length, frequency, and pattern of these highs and lows vary. Sometimes individuals with bipolar disorder experience frequent mixed states. Some of the different combinations of symptoms may not be medically significant, while others are important enough to be classified as specific types of bipolar disorder that may be treated in very different ways. For more information, see DBSA’s brochure, Guide to Depression and Manic Depression.

What is rapid cycling?

Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. With rapid cycling, mood swings can quickly go from low to high and back again, and occur over periods of a few days and sometimes even hours. The person feels like he or she is on a roller coaster, with mood and energy changes that are out-of control and disabling. In some individuals, rapid cycling is characterized by severe irritability, anger, impulsivity, and uncontrollable outbursts. While the term “rapid cycling” may make it sound as if the episodes occur in regular cycles, episodes actually often follow a random pattern. Some patients with rapid cycling appear to experience true manic, mild manic, or depressive episodes that last only for a day. If there are four mood episodes within a month, it is called ultra-rapid cycling, and when several mood switches occur within a day, on several days during one week, it is called ultra-ultra-rapid, or ultradian cycling. Typically, however, someone who experiences such short mood swings has longer episodes as well. Some individuals experience rapid cycling at the beginning of their illness, but for the majority, rapid cycling begins gradually. Most individuals with bipolar disorder, in fact, experience shorter and more frequent episodes over time if their illness is not adequately treated. For most people, rapid cycling is a temporary occurrence. They may experience rapid cycling for a time, then return to a pattern of longer, less frequent episodes, or, in the best case, return to a stabilized mood with the help of treatment. A small number of individuals continue in a rapid cycling pattern indefinitely.

Who develops rapid cycling?

As many as half of all people with bipolar disorder may develop rapid cycling at some time during their illness. While there are no absolute rules about who will develop this pattern, women may be more likely to do so, even though bipolar disorder is equally common in both genders. Use of certain antidepressants to treat bipolar disorder can bring on or worsen rapid cycling. Often, the cycling decreases when the antidepressant medication is stopped. However, when stopping an antidepressant, a person should be aware of the possibility of depressive episodes re-occuring, work closely with a doctor to find a more effective medication combination, and never stop taking a medication or change a dosage without first talking with a doctor about it. There may also be a link between rapid cycling and drug or alcohol abuse. A history of substance abuse may make an individual more likely to have rapid cycling. Studies also show that substance abuse is more common in families of people with rapid cycling than in families of people with bipolar disorder who do not have rapid cycling. It is not known whether this is the result of a genetic link between substance abuse and rapid cycling, or if it is evidence of “self-medication” among people with rapid cycling.

What causes rapid cycling?

The basic cause of rapid cycling remains unknown, but three overlapping theories exist:

Kindling (Sensitization):

According to the “kindling” theory, early episodes are triggered by actual or anticipated life events such as the death of a loved one or an upcoming job interview. Over time, the person with the illness becomes increasingly sensitive to more minor “triggers” or stressors, and becomes more likely to have an episode in response to these events. Eventually the person may begin to have episodes without any “triggers.” Episodes become increasingly frequent and the end result of this process, when the illness is not properly treated, may be rapid, ultra-rapid or ultradian cycling.

Biological rhythm disturbances:

This theory proposes that people with rapid cycling have daily biological rhythms that are out of sync with typical “time-giving” events such as dawn and dusk. This theory could account for the sleep disturbances typical of mania and depression and explain other symptoms as well. If biological rhythms are important, a link between rapid cycling and seasonal affective disorder (SAD) may be suggested. It is also possible that abnormal daily biological rhythms do not cause the illness itself but do contribute to the length and seriousness of a manic or depressive episode. For example, if insomnia is treated early and aggressively, mild or moderate symptoms can be prevented from snowballing into a severe and destructive episode.

Hypothyroidism:

This theory proposes that rapid cycling is due to inadequate amounts of thyroid hormone in the brain. Most people with rapid cycling do have adequate levels of thyroid hormone in the blood, but they may respond well to treatment with thyroid hormone regardless of their initial blood levels.

Are there effective treatments for rapid cycling?

Yes, although it can be challenging to find the right treatment. People with bipolar disorder shouldn’t give up hope if the first few medications or medication combinations prescribed are not successful. There are many different treatment options to try. Keep a good record of what has worked, has not worked, or has partially worked to help your doctor with future medication choices for you. For more information about medications for bipolar disorder, read DBSA’s Brochure, Finding Peace of Mind: Medication and Treatment Strategies for Bipolar Disorder. Be sure to talk to your doctor before adding any medication—including prescriptions, natural/herbal supplements and over-the-counter remedies—to your treatment.

Psychotherapy can be an important part of your treatment plan. Not only are people with bipolar disorder at risk for further manic or depressive episodes, it’s possible to experience difficulty as a result of past episodes. Characteristics such as irritability, tendency to cry, racing thoughts or impulsiveness may cause social problems. Because people with bipolar disorder are often unfairly judged, they may lose opportunities to develop friendships or romantic involvement, or have trouble achieving their career goals. These struggles may contribute to self-esteem problems. That’s why it’s helpful for people with bipolar disorder to consult their physicians or mental health professionals about one-on-one counseling and/or the benefits of couples, family, or group therapy. Discussing sticking to a treatment plan that works and managing and preventing suicidal thoughts can prove to be lifesaving.

Charting your moods can help you and your doctor identify patterns and things that cause stress, track your improvement on different medications or get an idea of when new episodes might occur. DBSA offers the Personal Calendar as a mood-tracking tool. This calendar has a place for you to record the medication you take each day, changes in your mood level, stressful life events, side effects and other symptoms.

Helping yourself, helping others: The value of local DBSA support groups

No one with bipolar disorder (rapid cycling or any other type) needs to feel alone or ashamed. With a grassroots network of nearly 1,000 support groups, DBSA offers an opportunity for people to meet and share coping skills, support and inspiration with others who understand. Each group has a professional advisor and an appointed facilitator. Members are people with depression or bipolar disorder and their family members. When combined with a treatment plan, DBSA support groups: Can help you stick with your treatment plan and may help you avoid hospitalization. Provide a place for mutual acceptance, understanding and self-discovery. Help you understand that a mood disorder does not define who you are. Give you the opportunity to benefit from the experiences of those who have “been there.” Take the next step toward wellness for yourself or someone you love. Call DBSA at (800) 826-3632 to find the DBSA chapter or support group nearest you, or click here. If there is no group in your area, DBSA can help you start one.

Conclusion

Research suggests that rapid cycling differs from other forms of bipolar disorder. Individuals with these patterns of mood changes may respond differently to standard and experimental treatments than other people with bipolar disorder. With its sudden and unpredictable mood changes, rapid cycling may be more difficult to manage than other types of bipolar disorder. This challenge makes it particularly important for people with this illness to work closely with their physicians and/or mental health professionals to get the best results possible, to stick with the treatment plan they are given, to find support and not to give up hope. As we learn more about the brain, many more treatments will become available. A great deal of progress has been made recently, and more discoveries are expected in the years ahead.

Being in control feels safe, but you can feel safe when you’re not in control too. The world is unpredictable and your power is limited, so feeling safe without control is a valuable skill.

When the world disappoints your expectations, your brain releases cortisol and it feels like an emergency. You can re-wire your brain to feel safe when you’re not in control. That doesn’t mean being out of control or giving up. It means building a new neural pathway to replace that old cortisol circuit.

Your brain will build a new pathway if you repeat a new thought or behavior for forty-five days. So give up control of something for the next six weeks and you will like the results!

Notice your usual strategy for feeling “on top of things,” and do the opposite. 
For example, if you are a person who tries to bake the perfect soufflé, spend forty-five days cooking without recipes. Conversely, if you are a person who likes to just throw things into a pot, spend forty-five days following recipes.

If you are a person who likes everything neat, let junk pile up for six weeks. But if you are a person who hates order and loves chaos, put things away as soon as you use them for six weeks.

Color outside the lines if that’s new for you, but if you already pride yourself on that, courageously stay inside the lines. It might feel awful on Day One, but forty-four days later it will feel curiously safe.

Don’t quit your day job to beg with a rice bowl. Just stop checking the weather report, buying lottery tickets, and expecting the world to work according to your rules. You will not like the cortisol at first, but you will train your brain to know that it doesn’t kill you. You will learn to feel safe in the world despite your inability to control it.

Getting rid of the clock is a great way to experiment with control, because you can’t control time.
We all have habits for managing the harsh reality of time. For some it’s chronic lateness and for others it’s constant clock-checking. You may think you can’t change your relationship with time, but here are three great ways to ignore the clock and make friends with the passage of time:

 

1. Start an activity without having an exact time you need to stop. Finish the activity without ever checking the clock the whole time. It’s over when you feel like it’s over.
2. Set aside a time each day to spend with no plan.
3. Designate a day you can wake up without looking at the clock and continue through your day with no time-checking.

No matter how busy you are, you can find a way to relax your efforts to control time. You may be surprised at the bad feelings that come up, despite your abiding wish to escape time pressure. The bad feelings won’t kill you, however, and accepting them helps you accept the harsh realities of time.

Your mammal brain feels good about things it can control. Some people break traffic laws to enjoy a sense of control, while others feel their power by scolding those who break traffic laws. Whatever gives you a sense of power won’t work all the time, however. You will end up feeling weak and unimportant some of the time. That triggers cortisol, but you can learn to feel safe when you are not in control.

Learn more about your mammal brain and building new neural pathways in my bookHabits of a Happy Brain: Retrain Your Brain to Boost Your Serotonin, Dopamine, Oxytocin, & Endorphin Levels.

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This article originally appeared on http://www.womenworking.com