Ultra Rapid Cycling
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Ultra-rapid cycling

Q: A very good friend of mine is diagnosed as being a rapid cycler. He is currently not taking any medications, because he says they caused too many side effects and he could not tolerate them. In the period of one day, he has about 4 to 5 episodes. He goes directly from being ok to being happy to being so depressed he does not want to live anymore. He constantly downs himself and I want so much to be able to do something for him, but I do not know what to do. I do know that he was using Cocaine, and I also know that he has stopped using it. At first I thought that may be it. But he still has these severe mood swings so many times during the day. He has cut his arms before, and I am so scared he is going to try to kill himself. Is there anything that you can suggest I do for him? Is it dangerous for him to not be on medications? I am just at a loss, and after searching the internet, can not find a site that tells me any of this. I can not even find a site where anyone has the different moods that many times a day. Thank you for your time.

Dear Terrie --
As you may have learned, it's hard to tell the difference between cocaine use and rapid cycling.  People can be very secret about their drug use, so we can't be too sure he's got "rapid cycling bipolar disorder" until it's just crystal clear he can't possibly be using coke.  Usually this takes an inpatient psychiatry unit stay (and even then one can't be really sure; sometimes we'll do some more drug screens to see).

But let's assume he's really "clean" and still having these super-rapid changes.  If the changes are really extreme, like the happy is more than just happy (see my website explanation of how subtle this "diagnosis" step can be: www.psycheducation.org, bipolar II section), and you conclude that indeed he may have bipolar disorder, then -- yes, it can really cycle that fast, although that's unusual.  You can do searches using the term "ultradian" for such cycle rates.  The treatment is basically the same as for "rapid cycling" -- mood stabilizers, no antidepressants.

Dr. Phelps

Published October, 2000

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