Rapid Cycling is a term you’ll come across often when you’re in bipolar spaces. Unfortunately, it means many different things to many different people.

So what is the DSM-5 definition of rapid cycling bipolar? 

“Presence of at least four mood episodes in the previous 12 months that meet the criteria for manic, hypomanic, or major depressive episode. Note: Episodes are demarcated by either partial or full remissions of at least 2 months or a switch to an episode of the opposite polarity (e.g., major depressive episode to manic episode).”

DSM-5 Page 150

In essence, if there are more than 3 hypomanic/manic/depressive episodes in 12 months AND the episodes are either 1) of opposite poles (depressive to manic or hypomanic to depressive) OR 2) have at least 2 months between them, then it’s rapid cycling bipolar.

So an episode of depression in January and a second episode of depression in February do not count towards a specifier of rapid cycling bipolar. 

Now, all that being said, the bipolar community has a very different definition of rapid cycling. Spending time in the r/bipolar subreddit, I’ve seen people describe mood shifts within a single day as rapid cycling, or mood shifts within a week, etc. Basically, when we hear the term rapid cycling we assume that it’s fast – as in days or weeks – when really, according to the DSM-5, it’s months. 

So you may hear people talking about rapid cycling and they mean a completely different thing than what a psychiatrist might mean when they say rapid cycling. 

Ultra Rapid Cycling and Ultradian Rapid Cycling

To complicate matters even further, there is also ultra rapid cycling and ultradian rapid cycling (also known as ultra ultra rapid cycling). 

I should note there is NOT scientific consensus on ultra rapid cycling or on ultradian rapid cycling, these are contested terms. 

Ultra Rapid Cycling – Generally considered to be multiple shifts within a month or so
Ultradian Rapid Cycling – Generally considered to be shifts within a 24 hour period

Ultradian Rapid Cycling, in particular, is especially contested as shifts within a 24 hour period do not meet the DSM-5 requirements for the length of time for hypomania (4+ days) or depression (2+ weeks). 

Sources

DSM-5

Ultra-Rapid and Ultradian Cycling in Bipolar Affective Illness by Keith G. Kramlinger and Robert M. Post, The British Journal of Psychiatry , Volume 168 , Issue 3 , March 1996 , pp. 314 – 323

Ultra-rapid cycling bipolar disorder: A critical look by Joseph F. Goldberg, MD, Accessed from MDedge.com, Originally Published Current Psychiatry. 2011 December;10(12):42-