rapid cycling vs "regular" cycle question

If a rapid cycling is a cycle a few times a year, then what does "regular" cycling look like?

Do the periods of depression and mania/hypomania have to be roughly the same length?

Thanx

I recommend forgetting completely about the DSM5 and its preposterous archetypes of our incredibly diverse and divergent illnesses, virtually none of which--if you dig deep with people here on PC who live it every day--accurately describe what it is like to live with bipolar disorder. It's a complete joke.

My absolutely genius, Harvard-trained psychiatrist, laughed when I began *****ing about this the other day in his office. He said he did not even own a DSM5, but had told them the last time they asked him to buy one that he would accept it were it on the house--so he could use it as a door stop. He really needs a new door stop.

Bipolar disorder type 1 does what a gorialla does--whatever it wants, whenever it wants. If you understand that, then you understand bipolar disorder.

Rapid cycling is generally if a person as more than 4 true episodes , episodes are defined of at least 2 solid weeks of depression and separate 2 weeks of Hypo for BP2 or manic BP 1 ... this happens over a rolling period of 12 months. So not a calendar year.

Often times people think they rapid cycle , but often it’s just a case of having not found true stability and stayed there for a good amount of time. A person needs to have there mood something solid to compare it with.

Just how my Pdoc , T and myself feel about “ rapid cycling”

If you are cyclical though the day then that a personality disorder not bipolar

I think the mania only has to be 1 week, and the hypomania more than 4 days, but it’s not really important for anything other than research. I only care whether or not my treatment is reducing or eliminating my symptoms. The diagnosis just gives the professionals ideas on how to treat the illness. One of my medications for my bipolar is a birth control pill. I don’t think that is standard treatment at all, but it means hormones don’t trigger a depressive episode. I’m glad my doctors were willing to use off label treatments.

Even then, it's not necessarily a personality disorder. Could be hormones or could be emotional dysregulation from something like ADHD, autism, etc.. Or if I'm being especially cynical, then I'd say that sometimes people who were previously on meds that made them emotionally "numb" or "flat" may suddenly (and mistakenly) feel like they're "cycling" again when they've finally regained the ability to feel emotions. It's because they're not used to feeling emotions. It's also just like people who've been heavily depressed for long periods of time and are very used to feeling horrible. Then when the depression lifts and their mood is euthymic, they suddenly think they're "manic," when in actuality, they're just feeling not depressed.

Quote:

Originally Posted by bpcyclist I recommend forgetting completely about the DSM5 and its preposterous archetypes of our incredibly diverse and divergent illnesses, virtually none of which--if you dig deep with people here on PC who live it every day--accurately describe what it is like to live with bipolar disorder. It's a complete joke. My absolutely genius, Harvard-trained psychiatrist, laughed when I began *****ing about this the other day in his office. He said he did not even own a DSM5, but had told them the last time they asked him to buy one that he would accept it were it on the house--so he could use it as a door stop. He really needs a new door stop. Bipolar disorder type 1 does what a gorialla does--whatever it wants, whenever it wants. If you understand that, then you understand bipolar disorder.

I cannot say it any better.

Good post

Okay ... as much as the DSM-V can be annoying but it’s a necessary evil in many cases. Unlike physical problems that can be proven with blood work or other testing. Psych ? Well that goes more off of what we as patients tell /show our providers.

It’s also needed for billing .... but more so it’s also needed because insurance companies like to deny meds xyz.... but more in depth diagnosis our insurance companies can see that okay ABC was tried and wasn’t helpful so yes we need to okay med x

Doctors are not chained to the DSM, it’s a tool.

As patients say Dr Joe Blow tags us with something that just does not fit and could cause us problems down the road with anything from jobs to insurances

I got tagged BPD once IP , the IP Pdoc thought he was freaking God , I refused a Med because we didn’t discuss it , sorry I won’t just swallow something. Boom I got my bpd medal

Anyway my personal Pdoc and T were pretty pissed... they both were very particular about “ coding” me correctly .. 4-5 months later the whole tag of BPD was totally dismissed out of my records

So yes sometimes the DSM can be a pain but it’s the only guideline we have right now to help our Pdocs narrow things down, find that slot we most fit into. It allows us to get treatments and medications.

And getting treatment for our symptoms and struggles is really what it’s all about , right?

I agree, Christina. In addition to the uses you have mentioned, it gives our health care providers some idea of the type of challenges we each deal with when we need to go from one provider to another. We can then each fill in the details, according to our own experiences..

While the story about the pdoc who refuses to possess a copy of the DSM may be a touch entertaining, I feel such a response is an irrational stance for any mental health professional to take, especially since the coding within the DSM is required for billing (in order for the pdoc to get paid). Admittedly, I hade a chuckle; yet, I imagine the pdoc has some purpose for the DSM and was exaggerating in order to relate his own misgivings about some of the classifications.

After many such discussions with many pdocs, both Harvard-educated and not, most have some misgivings about some aspects of any/every version of the DSM; yet, they also recognize the DSM is/can be very useful tool, as outlined by Christina.

Like so many things in life, the usefulness of the DSM in the practice of psychiatry isn't black or white.

I am so sorry you had to deal with an incorrect bpd diagnosis--what a flail.

I like the terms you used, "narrow things down" and "slot." We do have to be slotted in somewhere, or the doctors can't get paid and, as you point out, we can't get meds without a dx code. My real problem with the DSM5 is that, as it is now written, if you have, for example, the worst racing thoughts imaginable, racing thoughts so bad you literally are losing your mind, you do not qualify for any diagnosis--at all. I know someone who, when symptomatic, this is primarily what she gets. She is clearly bipolar, based on total history, but according to the bible, when she gets these symptoms, they do not constitute a bipolar "episode." And I think that is inaccurate. For her, that is inaccurate.

So, anyhoo, just to clarify what I meant. I sometimes have a bad habit of being curt when I get fired up and this topic fires me up. With apologies.

The DSM is an ever evolving book and likely always will be. Mental illness follows some loose guidelines but every edition is changed here and there because providers report problems or difficulty with what fits under each code.

Racing mind ? That can de described in so many ways there is always going to be a code for “ that feeling”

Insurance companies like to find ways to justify denial of a claim so Medical providers of all kinds have to keep sending formal complaints.

ICD9 code .... V97.33XD will always mean stuck in a jet engine. So just one example that ICD9 will make new codes when need be.

So although mental health diagnosis might shift or a bit fluid but your medical provider is going to match your symptoms to a code so your insurance will cover and your medication coverage will cover medications. Sometimes theres a bit of struggle for medications but a good providers staff will file the needed forms to get that medication approved.

Could the system be easier ? Sure but I think it’s working pretty well all things considered.

The DSM would be a better guide if big pharma stayed out of it. A lot of the failure from the newest one is directly attributable to paid docs who used their lobbying muscle backed by money from big pharma to twist the codes and push a drug response. That and the non medical information from government that has no place in the medical field.

Truth!!!!!!