The presence of rapid cycling is a predictor of poorer prognosis, including a longer course of disease and increased risk of comorbid substance use.2,3
References:
1. Koukopoulos A, Reginaldi D, Tondo L, et al. Course sequences in bipolar disorder: depressions preceding or following manias or hypomanias. J Affect Disord 2013; 151 (1): 105–110.
2. Carvalho AF, Dimellis D, Gonda X, et al. Rapid cycling in bipolar disorder: a systematic review. J Clin Psychiatry 2014; 75 (6): e578–586.
3. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition, text revision. Washington DC: APA; 2022.