Inside Bipolar Podcast: What Is Rapid Cycling? (And What We Often Get Wrong)

Meet Your Inside Bipolar Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

Episode Transcript:

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

​​Gabe: Hello everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: Dr. Nicole just to make sure that we are all playing with the same definitions. What is the absolute medical definition of rapid cycling?

Dr. Nicole: Rapid cycling is going to be four episodes in a 12-month period. That’s mania, hypomania, depression, but four of them. And we’re either looking for a period of normal mood or euthymia in between episodes, or we’re looking for a shift from one type of episode to another.

Gabe: And that’s it. That’s the whole definition?

Dr. Nicole: That’s the definition right there.

Gabe: That’s I you know, people in the bipolar community think that the definition is much longer. First off, we think that rapid cycling means you’re cycling rapidly. Right. Like you wake up in the morning with one mood and then you go to bed with like, we four in a year. Sounds just like bipolar disorder. I’m going to be honest with you. That sounds great. I think there are many people that wish that they were rapid cyclers. If they could just get to that four number. This is not what we believe. The definition of rapid cycling is in the bipolar community.

Dr. Nicole: I have a question, though. Does knowing the definition, do you think that makes somebody then believe they can achieve for or less If for is rapid? Is it helpful for a person with bipolar disorder to know that for is rapid?

Gabe: I think that it’s helpful for people with bipolar disorder or any medical illness to have all of the facts, especially if you’re running around saying the wrong thing. And especially, let’s say that you’re having six in a year, but you don’t believe that that’s abnormal because you believe that rapid cycling is having six in a day or six in a week. You might not see the need to seek help because you think, hey, that rapid cycler over there in my support group is having, you know, four episodes in a month and I’m only having six in a year. So therefore, by the art of comparison, which is not medical at all, we should never, ever compare ourselves to others. So, the answer to your question, which I answered very long, but the answer to your question is yes. I think it is absolutely helpful to be playing with the correct terms. It’s how we get the best care. Just out of curiosity, I want to throw the same question back at you. Do you think us having more information, the patient is better for you?

Dr. Nicole: Absolutely. Because then you’re not mad at me all the time or you are not thinking that it’s unachievable. So, if you don’t think that having less than four is even something that you can do, you’re not going to show up as often. You may feel defeated. You may not put as much effort into showing up and be as engaged when it comes to like making mad changes and stuff like that, because I’m always trying to get as long a period of normal mood as I can. But if you don’t believe it’s possible, then you’re the person who’s telling me not leave my stuff alone. Don’t. Don’t change my stuff. Like, don’t change it. So, I love I love it if you believe that that’s attainable because then maybe we can work a little bit more aggressively to get you there. So, let’s talk rapid cycling. Definition firm. Four episodes in a year. And so, some people that sounds like well, that doesn’t sound rapid at all. Like that just sounds like.

Gabe: Yeah. Yeah. It completely lacks. If I got four pizzas in a year or it took

Dr. Nicole: Wow.

Gabe: Three months to get me a pizza, I would,

Dr. Nicole: [Laughter]

Gabe: I would not, I would not think that was rapid.

Dr. Nicole: Eating pizza isn’t quite as disturbing to your functioning as having either depression or mania or hypomania. So, I think that’s not quite a fair comparison.

Gabe: Look, I’m not good at analogies. I’m. I might be rapid analogy. Cycling.

Dr. Nicole: But I do know a lot of people hear that and they think, well, like that doesn’t sound rapid at all. And I’ve had patients tell me that’s dumb. That doesn’t make sense. That’s not rapid. So, I’m going to further complicate this whole discussion. There’s also ultra rapid cycling and ultra

Gabe: What? You’re adding words?

Dr. Nicole: We were adding words. We’re adding words. So, there’s ultra rapid cycling, which is the shifts that occur every few days, right? So, we see that ultra rapid cycling. I think most people who have bipolar disorder have experienced because certainly a lot of my patients are telling me I don’t meet the fool. Like I might not have the manic symptoms for a full week. I may not have the depression symptoms for a full two weeks, but I’ll have a few days or maybe five, six days or maybe a week where I feel depressed and I’m legit depressed. Like you can’t tell me I’m not depressed because it’s not two weeks. So, we have this ultra rapid cycling and then to make it even more complicated.

Gabe: What are you doing to us? What are you doing to us, Dr. Nicole?

Dr. Nicole: Some believe that there is ultra, ultra rapid cycling. And I know that sounds like I totally made that up and that I’m just over here going, ultra, ultra, ultra. No, but there is a thought that there is ultra, ultra rapid cycling, which is what most people describe when they say rapid cycling. It’s the within a day. I’m manic early in the morning, but by bedtime I’m depressed. That kind of description. And the reason I say it there is thought truly the only one we have a very firm definition and consensus on is the rapid cycling. There’s a lot of controversy within the mental health community among psychiatrists and people who diagnose is ultra rapid cycling a thing Is ultra, ultra a thing. Some people believe, yes. Some people give the look that you just gave, like y’all making stuff up. This is not real. So even within us, our group of psychiatrists in the world, we can’t even agree on whether these things are legit or not.

Gabe: First, I don’t want to miss the opportunity to make the Fast and the Furious connection. Right. Just you’ve got Fast and Furious. That’s one movie. And you’re like, okay, Fast and Furious, that goes together. But now we’re on ten. So now it’s like the super fast, the super furious, the in the sky, the in the car, the ultra, ultra, ultra, ultra, ultra, ultra, ultra x, because they just they just ran out of names to intrigue people. And I just I have so much to say about this. The first thing I want to say is I can see where people misunderstand what rapid cycling is. Let’s go back to the hard and fast definition of four or more episodes in a year. That’s the medical definition. That’s what all the Doctor Nicole are out there looking for so that they can help get us the best treatment that we can. I can see where this misconception arises because if I had four episodes in a year, I would think that I had bipolar disorder. Like I wouldn’t I wouldn’t I wouldn’t think that I had anything extra. I would just be like, hey, I have the symptoms of the illness that you diagnosed me with.

Gabe: I when we get to the ultra and the ultra ultra, whether they’re true or not is really irrelevant for this conversation right now because we tend to go to the doctor and talk to our Dr. Nicole’s when something is really, really bothering us, there’s this little piece of Gabe that is like, Look, if I could keep the same mood for three months, I don’t know that I would consider that a problem. But if I was cycling every single day or multiple times in a day, that’s when I would go tell somebody. And of course, that’s when I would get this rudimentary education that, hey, you know, you’re suffering from rapid cycling or ultra rapid cycling or ultra, ultra rapid cycling. Of course, I’m getting this information while in crisis. And then, you know, a little bit of knowledge is a dangerous thing. And then because of the name rapid cycling and then it starts to spread throughout the community that, hey, if you’re shifting your moods in the same day, you have rapid cycling, which I would like to point out is accurate. It’s just not accurate the way many people in the bipolar community think that it is.

Dr. Nicole: That’s true. That’s true. And, you know, you brought up something that I want to make sure I point out. People will see me. The stable person who has bipolar disorder will come back and see me every three months or so, and they’ll say, oh, yeah, I’m fine. Like everything’s good, no problems, everything’s great. And in digging, I find out, well, but like once a month I kind of have this blip of a mood episode. But I just thought that was just a normal part of having bipolar disorder. So, I just don’t tell you about those things. I’ve been having that for years. No, we need to know if you’re having episodes because you can literally go years without an episode. I have people who have gone years with no depression, no mania, no hypomania. That’s the goal. Always. We may not achieve it, but at least let us work towards it.

Gabe: Now, let’s put a little asterisk on this. I know that the goal is to be symptom free, that that’s my goal. That’s everybody’s goal. But specifically, you said that people go months, years, even longer with no symptoms. And that’s the goal now. Is that the goal in treatment or does that happen without treatment?

Dr. Nicole: Bipolar disorder is an episodic illness. And that is a lot of times why people are waiting so long to get into treatment because of the fact that they say, well, I, I mean I went two years. This hasn’t happened to me. In two years. I’ll see people in the hospital who are full blown mania. And I try to get history and they’re like, No, I’ve never taken any meds. I’ve never really seen anybody. And I’m like, Has this ever happened before? They’re like, Yeah. Five years ago, I got drug into the hospital over some bogus reports of blah blah, blah, which are very similar to the current bogus reports of blah, blah, blah. And we realized I, I think that that was a manic episode also. So, it’s not quite as clear as we would like it to be. But with or without, it’s episodic.

Gabe: I have some questions, Dr. Nicole, and I want to let the audience know that that I was one of those people that believed that rapid cycling was multiple episodes in a day, like literally rapid cycling. And I was also one of these people who woke up in the morning and I would be manic and I would go to bed depressed and then I’d be up for three days with mania and then I would be depressed for a week. And it was happening really rapidly. And that’s when I learned about rapid cycling. So that was I’m not picking on the audience. I was one of the people who believed this. And in doing this work and working with Dr. Nicole, people were like, Dude, that’s wrong. Like, you could not be more wrong. So, then I put my little thinking cap on. I’m going to call it my bipolar thinking cap. And I thought for four and a year, why is that a concern? Why did somebody bother to name this? And that’s my question to you, Dr. Nicole, what difference does it make if somebody has four mood episodes in a year? Is that really any different than someone who has two or someone who has five? How does this help you help us?

Dr. Nicole: Well, our goal is always to have as few of episodes as possible, especially when it comes to manic episodes, hypomanic episodes. The more of those you have, the more it can in time become difficult to get control of them with the same meds or the same amount of medication. So, we want you to have as few as possible. And remember, we still are clueless about the brain. There’s still so much about bipolar disorder and schizophrenia and illnesses like that that we just still are trying to figure out.

Gabe: You know, this kind of reminds me of? So, if you’re in an airplane and you’re sitting upright, it’s safe. But if you recline that seat back two inches danger. So much danger. And that’s why your seat has to be in the upright and locked position when you land. Otherwise, those two inches, these are a very, very serious two inches.

Dr. Nicole: Chaos.

Gabe: My curiosity is why do we need the label of, like you said, the goal is zero. The goal is always going to be zero. And I agree with you. I want the goal to be zero, too. Why did somebody say, okay, look, here’s what we’re going to do if they have three or less, but if they have four or more, we’re going to call it rapid cycling. And that’s going to how is that going to factor into the treatment? Just putting that label on the four or more, does it matter?

Dr. Nicole: I think it gives perspective. I think it you know, when you do research enough and you do enough research and have enough data in front of you to say that, okay, this percentage of people has these number of episodes, if we feel like, oh, that’s on the excessive side, we want to be able to help that. You know, people research things. We like to name things in medicine. We can’t help ourselves. But ultimately, the answer to your question of does it matter to me kind of if a person has bipolar disorder? My goal is always to give them as many symptom free days in life as I possibly can. And to me, it doesn’t matter if I’m calling it ultra ultra infinity cycling, I don’t care because my goal is the same. So, in that sense, no, it doesn’t matter to me what we call it.

Gabe: I often talk about this a lot in the bipolar community that the names are really irrelevant if you’re getting the care that you need, if you’re getting the treatment that you need, if everything is going well, you know, you can call it Cat in the Hat for all I care if I’m living my best life, I’m really not concerned about the label. And as you’re fond of saying, Dr. Nicole, the brain is like this final frontier. We don’t really understand it. Even our medications are we’re not sure the mechanism in which it works. However, we know via studies that it does work. So, we are in fact taking that as a win.

Dr. Nicole: Yeah.

Gabe: There’s probably a whole other episode on why that is terrifying, but when it comes to rapid cycling, there are a lot of people in the bipolar community that they really latch on to this label. And

Dr. Nicole: Mm-hmm.

Gabe: I’m not 100% sure why, but from my perspective, I latched on to it because I was terrified of it.

Dr. Nicole: Mm-hmm.

Gabe: I described it as a whiplash effect. So, you can see where I’m struggling here to try to be reasonable in this podcast because rapid cycling isn’t actually a whiplash effect because it four episodes in a year doesn’t sound like much of a whiplash, but in my mind it’s a whiplash. It’s back and forth and back and forth and up and down and back and forth and up and down. And you’re like, Ah, that’s not true. But this is some people. It is. So

Dr. Nicole: Uh,

Gabe: Make sense of that for us.

Dr. Nicole: I think the reason most people latch on to it is because they want me to and the me’s of the world to understand. They want me to understand that this is disruptive. So, when somebody is specifically telling me I have ultra rapid cycling or I’m a rapid cycler, they are saying that because they want me to know. That their illness is causing them a little bit more disruption than maybe the average bear. And that’s what they want me to know. So usually when somebody makes a point to point out their ultra rapid, ultra, ultra or whatever that is, it’s because they want me to know how serious it is.

Sponsor Break

​​Dr. Nicole: And we’re back talking about rapid cycling, ultra rapid cycling, and ultra ultra rapid cycling in bipolar disorder.

Gabe: All right, Dr. Nicole, let’s get down to brass tacks. All right. You or a loved one is a rapid cycling bipolar. And you’re like, okay, I’m on board. I’m on board that this is what it is. It’s four in a year. What are my treatment options? What should I do differently with this knowledge?

Dr. Nicole: Speak it out loud to the person who prescribes your medication. They need to know.

Gabe: No, no. You told us. You told us.

Dr. Nicole: Oh.

Gabe: You were like, Gabe, you are rapid cycling.

I told you that? Like I told you were rapid cycling?

Gabe: I mean, that’s. That’s reasonable. Shouldn’t you tell me?

Dr. Nicole: I don’t know that I’ve ever used the words. You’re a rapid cycler to a patient. I will be completely honest with you. I do not know that I have ever told a patient that they were a rapid cycler, an ultra rapid cycler or an ultra ultra rapid cycler. They come to me with that information because to me clinically and how I practice, I don’t really care if you’re rapid, ultra, ultra, ultra, I don’t care because my goal is still the same. So, we’re still adjusting and doing what we need to do. Now, where I do care is if you come at me and tell me you’re an ultra ultra, my ears are going to perk up and I am going to start questioning, Is your diagnosis accurate in the first place?

Gabe: So, tell me about that. Could this be indicative of a larger problem or an inaccurate description? Because again, in the bipolar community where I spend all of my time, remember, I am not a doctor, Nicole. I am not hanging out. Dr. Nicole is the only doctor who will hang out with me and I pay her. Right. No doctors hang out with me for free, but I spend a lot of time with my fellow people living with bipolar disorder. And we do throw this around

Dr. Nicole: Uh-huh.

Gabe: In a much different way. And whether it’s scary or not, scary is sort of irrelevant to the equation.

Dr. Nicole: Mm-hmm.

Gabe: I’m still struggling to figure out why this even matters. Let me let me explain it this way. If you have a cough, I can understand that you might have a bad cough. And of course, we’ve heard things like productive cough versus nonproductive cough, but the amount that you cough is there’s not like a label, you’re not called a rapid cougher, right. How you cough. I mean, things like that. I suppose they’re diagnostic to the doctor perhaps, but nobody ever says I’m a rapid cougher or I’m a shallow cougher or I’m a deep cougher. It’s just I have a cough. How much do you cough? A little or a lot. So, I could understand if the conversation was I have symptoms, would you have a lot of symptoms or a little bit of symptoms that tracks for me?

Dr. Nicole: Hmm.

Gabe: Where I get confused is okay, well, the number of symptoms that you have puts you in this other category. And I’m still sitting here thinking, why does that even matter? Because, again, the goal is zero.

Dr. Nicole: The goal is zero. And like I said, treatment wise for me doesn’t make a lot of difference. But it matters in the sense that bipolar disorder is defined by episodes. So, we have to have some way of defining it, I guess. And so, if that’s rapid, ultra, ultra, ultra, whatever that looks like. But back to the what if I’m wrong? What if it isn’t bipolar disorder? What if

Gabe: Yeah.

Dr. Nicole: You’re ultra ultra rapid cycling is something else? What if it’s borderline personality disorder?

Gabe: Does rapid cycling look like other disorders, like you mentioned, borderline personality disorder. Is that a thing?

Dr. Nicole: Not rapid cycling necessarily. I mean, that’s four episodes in a year. We’re talking 12 months. That’s a long time. I think we can all wrap our hands around that. When we get to the ultra ultra that’s where the controversy kind of comes in for some people because the whole I’m depressed one part of the day and then I can be manic for five hours and then the next day I’m okay. That level of cycling kind of perks some of our ears up, like I said, and we start thinking about is this bipolar disorder? Can a person have both? Absolutely. You can have bipolar disorder and borderline personality disorder. Let’s just make it even more complicated. But there are some people who think that borderline personality disorder is a type of bipolar illness. Because of the fluctuations in mood, the rapid shifts in mood, the reactivity of the mood. So, there are some people who even believe that. So, we still are back and forth about what does this even mean? But I feel like I owe it to every patient I see. If somebody tells me they’re in ultra, ultra rapid cycler because they read it and it sounds just like them, I feel like I kind of owe it to them to at least tease out, are we right? Because we could be wrong. Remember, you could have been diagnosed with bipolar disorder in era, which sometimes happens. I can’t sit here and tell you it doesn’t.

Gabe: We did a whole episode on diagnosis flip flop. We gave it a cute name to make it sound less scary. But of course, the entirety of the episode was that you get diagnosed with one thing and then more data becomes available. So, you get diagnosed with something else and then more data becomes available. So, you get diagnosed with something else and it seems like you’re flip flopping when in reality this is just what science looks like. This is just what doctoring looks like. If you’re so rigid that you think that somebody gets it right out of the gate and you never, ever change, you put yourself in more harm’s way than being flexible to the idea that the diagnosis could and often does change. So just I just want to remind our listeners of that who and hey, go listen to the diagnosis Flip Flop episode and learn more. I’m still hung up. I know, I know. This is just me personally and but it is many people in the bipolar community. I always described bipolar disorder when I was untreated as a whiplash effect before I ever heard the words rapid cycling. I always said the problem with bipolar disorder is the whiplash. It’s the mood. One minute I think that I am a deity. I think that I am standing on high and that I am the greatest thing to ever live. And within 24 hours, I think that if I died, my mother and grandmother would celebrate at my funeral and be so glad that I was dead. And the thing that it did to me personally was just again, it that’s a whiplash effect to go from thinking you’re the greatest to you’re the worst in a 24-hour period is emotionally traumatizing and damaging. And when people throw around rapid cycle or rapid cycle or rapid cycler. Is it just wrong? I mean, is it just should we use other words? Should we just say your moods have I want to coin the phrase bipolar whiplash. Where’s Stanford and Johns Hopkins. Why are these people? I’m ready to publish. I’m ready to publish right now.

Dr. Nicole: Okay. These sound a little grandiose right now because that’s not going to happen.

Gabe: Oh, there it is.

Dr. Nicole: [Laughter]

Gabe: You get excited.

Dr. Nicole: Not gonna happen

Gabe: About a break, a medical breakthrough

Dr. Nicole: [Laughter] That’s not going to happen.

Gabe: That you’ve had on a podcast, and suddenly people think you have grandiosity.

Dr. Nicole: That’s not going to happen. We’re not going to call it bipolar whiplash. That doesn’t, we’re not going to do that.

Gabe: I know we’re not going to change the name, but it is it. I, I think maybe the specific question that I’m asking you, Dr. Nicole, as a practitioner is when people tell you, personally I’m a rapid cycler. Do you think they’re conveying that they’ve had four episodes in a year or do you think they’re conveying that they wake up one day thinking they’re the greatest and they go to bed the next evening thinking they’re garbage?

Dr. Nicole: I don’t ever assume they mean one or the other. I ask clarifying questions. Because do you know how often somebody gives me their definition of something that is not my definition of something? I mean, the perfect example is I ask people if they have panic attacks and they say, no, I’ve had anxiety attacks, though. And I ask them, well, what is an anxiety attack to you? And they give me what I define what the DSM defines as a panic attack. So, I think in general, the medical world has definitions that we use and we can be very rigid about those definitions and names and stuff. But the average person, they’re not going to get it like it happens all the time. I ask people about paranoia and they start saying, Oh yeah, I’m paranoid, and then I dig a little deeper and find out they’re not paranoid. They have a trauma history and they’re hypervigilant because they’ve been robbed before. So, when they’re walking and they’re watching their back, that’s not paranoia, right? That’s something different. So, I know that I really can’t trust anything that anybody tells me that I have a definition for it to mean what I think it means. So, I’m always asking, now, does every doctor do that? I sure hope so. Do I know for a fact that some don’t? Unfortunately, I do. But. But I mean that that is how it should happen. So, the we have to make sure we’re speaking the same language. And a lot of times we just are not. So, I pretty much assume when I hear rapid cycling, I, I probably give this like sit my pin down look and I just say, well, what exactly does that mean to you? Because I pretty much know that 9.8 times out of ten, it does not mean what I think it means.

Gabe: I really like what you said there about you’ve got to ask more questions and you’ve got to be flexible on this because people use terms incorrectly all the time. And I’m always quick to point out that that’s not just a bipolar thing. You know, my father and I love my father. And any time I start off anything with my father and I love my father, you know, I’m about to just, you know, about to just embarrass him.

Dr. Nicole: You’re about to roast him on a podcast.

Gabe: I am my father is one of those patients who, when he goes to the doctor, he tells the doctor what he needs. He walks in and he’s like, Hi, I have pneumonia. I need a z-pack. I don’t I don’t know what a z-pack is. I don’t know what it has to do with pneumonia. And I don’t know why. My dad, the retired Teamster who drove a semi-truck, is doing telling the doctor. And then he says, my favorite line, which is I know my body. I want you to know he does not know his body. He’s been wrong 100% of the time. He is never correct. They run it and they’re like, you have the flu, you have asthma. So, it’s I think it’s just part of human nature. This this, quote unquote, I know my body mentality and especially when we’re dealing with something like our brains, like we’re really uncomfortable with the idea that we don’t know what’s going on in our heads. We don’t know what’s going on with our emotions, with our moods and phrases like rapid cycling. They’re sort of nebulous in the bipolar community. And we get really, really attached to what we believe leave the definition is, and then we get really, really defensive when that definition changes, even if it’s in black and white, that we were wrong all along, it feels like we’re being told that we don’t understand our minds, which is you can see where that would be incredibly traumatizing and something that someone would want to hold on to. So, what I want to say to the bipolar community is, you know, maybe instead of going in and saying I’m a rapid cycler or whatever you want to fill in, this episode just happens to be about rapid cycling. You should say, I’m having these symptoms. What do you think it is?

Dr. Nicole: And ultimately, we need to be speaking the same language so that we can get to the same destination together. We need to we need to have the same understanding of what’s going on. And I am typically more concerned about why you felt the need to tell me that you were a rapid, ultra, ultra, ultra rapid cycler. Uh, more so than I am what we’re calling it, and what it looks like. And this happens in all industries. Every industry has its own jargon that other people don’t understand. I cannot tell you how many bad hair experiences I’ve had because I have told my hairdresser I wanted a certain thing which meant something totally different to my understanding versus his. And then I ended up unhappy on the back end only to find out I wasn’t speaking the right language and he didn’t clarify. So, I think every industry has it. It’s just that in medicine the stakes are higher, right? It’s just hair for hair. But the stakes are much higher because we’re talking about your livelihood, your mental health, your functioning. But every industry has jargon.

Gabe: And of course, with bipolar disorder, it’s also much more emotional and triggering to be told you’re wrong. I you know, there’s a subplot here, which is if you have an adversarial relationship with your provider, they’re probably not a good provider. You really do need to have that partnership because they just can’t run a test. Dr. Nicole can’t just get blood work or a urine sample and figure it out. The two of you have to communicate. And we know that in human as you said, Dr. Nicole misunderstandings happen all the time. They happen all the time with the people in our lives, our spouses, our friends, our parents, the people that we’ve known for 30 years. We have misunderstandings with. And many of us are seeing our doctor Nicole for 15 minutes every six weeks. If you have like Cadillac insurance, right? That’s like

Dr. Nicole: Cadillac insurance?

Gabe: That’s like the Mercedes Benz insurance, you get a whole 15 minutes every, you know, all joking aside,

Dr. Nicole: Yes.

Gabe: They’re not going to pick up on your little tells. I, I just I do think that that’s worth pointing out because again to pull it back to rapid cycling. It’s just one of those words that I really do believe that if you ask ten different people living with bipolar disorder what rapid cycling meant, you would get ten different responses. And hey, if they’re living their best life, they can define it however they want. The problem is we talk to each other, we talk to each other, and we may deliver accidentally, inadvertently the wrong information to somebody who is now relying on it for their care. And that just causes all kinds of issues.

Dr. Nicole: And you said that if you have an adversarial relationship with your doctor, they may not be a good doctor, but they may just not be a good doctor for you.

Gabe: That’s fair, that’s fair.

Dr. Nicole: They may not be one for you. I will tell you, for every nine patients who will sing my praises and love me, there’s going to be one who is calling me very bad names So I think it just depends. You know, if I catch you on a bad day and on that bad day, you make up in your mind that that’s who I am to you, that that may always be who I am to you. So maybe things happen and you’re just not able to move through them. And then if your relationship continues to be that way after that one incident, then maybe you do need to change. Or maybe you need to have a conversation about what your beef is with that person and explain to them why you’re mad at them. Because sometimes once the episodes are clear and you’re thinking clearer and cooler heads can prevail, sometimes we can actually move through the you calling me very bad names on the Internet.

Gabe: Dr. Nicole, thank you so much for calling me out on that because you’re absolutely right. Not a good doctor for you is absolutely what I meant. But that is not what I said. And I also want to say, you know, listen, if your rapid cycling through four or more doctors over a year, it might be you. You know, so often in the bipolar community, we are so quick to say, oh, all doctors suck. I’m getting all bad doctors. But again, if your rapid cycling through those doctors, you might want to turn the microscope around. Dr. Nicole the bottom line is rapid cycling. What it actually means is four or more episodes in a year, it is diagnostic for the Doctor Nicole of the world to help us get the best care. Now, there is there is asterisks is on there, ultra rapid cycling and ultra ultra rapid cycling, which just seems to be more and more and more symptoms. I really think the bottom line in this whole rapid cycling topic is you want to have as few as symptoms as possible.

Gabe: Obviously, the goal is zero, but that might not be an attainable goal, but we want to be as symptom free as we can get. And whether it’s rapid cycling, ultra rapid cycling, ultra, ultra rapid cycling, it’s just a way to determine how fast you are cycling, how many mood episodes you are having in a year. And that sort of diagnostic criteria is very important to getting the right care. So that’s where all of these terms come in. And I think it’s important to understand that now. And honestly, once you set me straight, Dr. Nicole, I was like, okay, well, maybe we shouldn’t do this as a topic because I really thought the episode was going to be, guess what, everybody, we don’t know what rapid cycling actually is. Then Dr. Nicole would tell us what it is, and then we would fade to black and then we’d be out. So, I’m impressed with us. I’m impressed that we were able to discuss rapid cycling for as long as we did so. So, thank you, Dr. Nicole, for coming along with all of us for the ride.

Dr. Nicole: It was fun. I did have my doubts initially, but this was a really good topic. And ultimately stable is relative. Better is relative. Zero symptoms is relative. Rapid cycling has a definition, but we don’t care.

Gabe: I love that as the ending. Listen up, everybody. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon because, well, everything is on Amazon. But if you want a signed copy with free swag, head over to my website at gabehoward.com and check it out there.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych to see what I’m doing at any moment.

Gabe: Dr. Nicole and I both travel nationally. If you want to hire us separately or together, check out our respective websites and you can set that up. And please do us a gigantic favor. Wherever you downloaded this episode, please follow or subscribe. It is absolutely free and also share it, share it on social media, share it in an email, share it in a support group. Hell, send your buddy a text message. Sharing the show is absolutely how we grow. We will see everybody next time on Inside Bipolar.

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