Editing Bipolar disorder (section)

==== Rapid cycling ====
Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months.<ref>{{cite journal | vauthors = Angst J, Sellaro R | title = Historical perspectives and natural history of bipolar disorder | journal = Biological Psychiatry | volume = 48 | issue = 6 | pages = 445–457 | date = September 2000 | pmid = 11018218 | doi = 10.1016/s0006-3223(00)00909-4 | type = Review | s2cid = 6629039 }}</ref> ''Rapid cycling'', however, is a course specifier that may be applied to any bipolar subtype. It is defined as having four or more mood disturbance episodes within a one-year span. Rapid cycling is usually temporary but is common amongst people with bipolar disorder and affects 25.8–45.3% of them at some point in their life.<ref name="Muneer2013">{{cite journal | vauthors = Muneer A | title = Treatment of the depressive phase of bipolar affective disorder: a review | journal = The Journal of the Pakistan Medical Association | volume = 63 | issue = 6 | pages = 763–769 | date = June 2013 | pmid = 23901682 | type = Review }}</ref><ref name="Buoli2017">{{cite journal | vauthors = Buoli M, Serati M, Altamura AC | title = Biological aspects and candidate biomarkers for rapid-cycling in bipolar disorder: A systematic review | journal = Psychiatry Research | volume = 258 | pages = 565–575 | date = December 2017 | pmid = 28864122 | doi = 10.1016/j.psychres.2017.08.059 | s2cid = 13653149 | type = Review }}</ref> These episodes are separated from each other by a remission (partial or full) for at least two months or a switch in mood polarity (i.e., from a depressive episode to a manic episode or vice versa).<ref name="Barnett2009" /> The definition of rapid cycling most frequently cited in the literature (including the DSM-V and ICD-11) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes during a 12-month period.<ref name=Bauer2008>{{cite journal | vauthors = Bauer M, Beaulieu S, Dunner DL, Lafer B, Kupka R | title = Rapid cycling bipolar disorder—diagnostic concepts | journal = Bipolar Disorders | volume = 10 | issue = 1 Pt 2 | pages = 153–162 | date = February 2008 | pmid = 18199234 | doi = 10.1111/j.1399-5618.2007.00560.x }}</ref> The literature examining the pharmacological treatment of rapid cycling is sparse and there is no clear consensus with respect to its optimal pharmacological management.<ref name=Fountoulakis2013>{{cite journal | vauthors = Fountoulakis KN, Kontis D, Gonda X, Yatham LN | title = A systematic review of the evidence on the treatment of rapid cycling bipolar disorder | journal = Bipolar Disorders | volume = 15 | issue = 2 | pages = 115–137 | date = March 2013 | pmid = 23437958 | doi = 10.1111/bdi.12045 | type = Systematic Review | s2cid = 20001176 | url = http://repo.lib.semmelweis.hu//handle/123456789/514 }}</ref> "Ultra rapid" and "ultradian" have been applied to faster-cycling types of bipolar disorder.<ref>{{cite journal | vauthors = Tillman R, Geller B | title = Definitions of rapid, ultrarapid, and ultradian cycling and of episode duration in pediatric and adult bipolar disorders: a proposal to distinguish episodes from cycles | journal = Journal of Child and Adolescent Psychopharmacology | volume = 13 | issue = 3 | pages = 267–271 | date = 2003 | pmid = 14642014 | doi = 10.1089/104454603322572598 }}</ref> People with the rapid cycling or faster-cycling subtypes of bipolar disorder tend to be more difficult to treat and less responsive to medications than other people with bipolar disorder.<ref name="Post2016">{{cite journal | vauthors = Post RM | title = Treatment of Bipolar Depression: Evolving Recommendations | journal = The Psychiatric Clinics of North America | volume = 39 | issue = 1 | pages = 11–33 | date = March 2016 | pmid = 26876316 | doi = 10.1016/j.psc.2015.09.001 | type = Review }}</ref>