Along with the presence of rapid cycling, it can be important to note the type of cycling in people with bipolar disorder.1,2 The order of symptoms, i.e., depression-then-mania compared with mania-then-depression, can be associated with different responses to treatment and with different clinical symptoms across the course of the disease.1
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.