I have mixed and rapid cycling bipolar disorder. I have looked everywhere for info but to no avail. Is this bipolar version harder to treat than the other bipolar disorders? Will I be able to live a normal life ever? Can I work again?
You are right to be looking for specific information about mixed and rapid cycling bipolar disorder, as these are very specific forms of bipolar disorder (manic depressive illness) with their own characteristic symptoms, course, and treatment response.
Classic bipolar disorder is characterized by severe mood swings from very low depressions, which can last weeks to months, to very high, out-of-control manic periods, which also tend to last weeks or months. Typically, someone with bipolar disorder runs through one or two cycles a year, generally with manic episodes occurring in the spring or fall.
In rapid cycling bipolar disorder, however, the mood swings go rapidly from low to high and back again, and occur over periods of mere days and sometimes even hours. The person feels like he or she is on a severe roller coaster, with mood and energy fluctuations that are out-of-control and debilitating. This is quite different from just being a moody personality, or from having the normal shifts in mood we all experience over the course of a day or a week. In some individuals, the rapid cycling is characterized by severe irritability, anger episodes, impulsivity, and uncontrollable outbursts.
Many people with rapid cycling forms of bipolar disorder also have what we call “mixed states.” This means that the moods they experience are not easily identified as pure depression and pure mania. Instead, they can experience both extremes at the same time. Typically, they will 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, and wild swings between racing thoughts and a feeling of being in blackness can all happen over the course of minutes. It is a very unpleasant state to be in, and one which predisposes many to substance abuse and suicide and also, at times, violent behavior.
Some studies indicate that women may be more prone to rapid cycling forms of bipolar disorder. It appears that the injudicious use of antidepressants, particularly when prescribed without the simultaneous use of a mood stabilizing agent, can provoke rapid cycling and perhaps also mixed states in predisposed individuals. Lithium, carbamezepine (Tegretol), valproic acid (Depakote), gabapentin (Neurontin), lamotrigine (Lamigdil) and topiramate (Topamax) are all examples of mood stabilizers.) It is very important to get immediate, vigorous, and state-of-the-art treatment for this form of bipolar disorder, since, the longer someone goes without treatment, the more refractory the symptoms can get.
You should seek the care of a psychiatrist who specializes in mood disorders, and who is experienced in evaluating and treating rapid cycling bipolar disorder, using the newest findings and medications. For example, some patients are finding relief with low doses of the antipsychotic medication such as olanzapine (Zyprexa). Some patients also respond well to a regimen that includes high doses of omega-3 essential fatty acids (found in fish oil). I know of many highly intelligent, hardworking people who are successfully treating their rapid cycling bipolar disorder with a combination of these medications, psychotherapy, and healthy lifestyle changes. So yes, you can feel much better. The key is vigorous, state-of-the-art treatment with a psychiatrist who is experienced with that disorder.