What Are Racing Thoughts in Bipolar Disorder?

When Racing Thoughts Aren't the Same as Thinking Fast

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Racing thoughts are not just "thinking fast." They are thoughts that just won't be quiet. They can be in the background of other thoughts or take over a person's consciousness, and they can gallop out-of-control around and around in the sufferer's head.

In some people, thoughts and music zoom through their heads so fast that it's nearly intolerable. People with bipolar disorder report having to concentrate for an hour or more on word games in order to quiet the thoughts and eventually fall asleep.

Components of racing thoughts can include music, snatches of conversation from movies or television or books, your own voice, or other voices repeating a phrase or sentences again and again. They can involve rhythms of pressure without any "sound" in the thought. Sometimes, racing thoughts are accompanied by a pounding heart or pounding pulses, including drumming in the ears.

The phenomenon called "racing thoughts" is distinct from "hearing voices," which is found in psychosis and is a symptom of schizophrenia, schizoaffective disorder, severe mania or other psychotic disorders. Racing thoughts can be a symptom of mania or hypomania in bipolar disorder.

Racing Thoughts in Bipolar Disorder

When someone with bipolar disorder is entering or has entered a hypomanic or manic state, racing thoughts are common. According to one study, "In the context of a hypomanic state, 'racing thoughts' may appear as a result from an excessive production of thoughts, moving quickly from one to the other, and generating a sense of fluidity and pleasantness."

In fact, the existence of racing thoughts in someone who hasn't been diagnosed with bipolar disorder may indicate a susceptibility to the condition.

What the Research Says

A study published in 2013 looked at more than 40,000 people who had previously reported symptoms of elation or irritability. The study found that people with those symptoms who also had racing thoughts, trouble concentrating or hyperactivity were more likely to later develop bipolar disorder.

The researchers said these results may suggest the need for a cautious approach in prescribing antidepressants to people with these symptoms since antidepressants may trigger mania in people with bipolar disorder.

Another set of researchers assessed symptoms in 52 teenagers who had been diagnosed with bipolar I disorder. They found that some 60% of the teens experienced racing thoughts many months prior to developing full-blown bipolar disorder. Half the teens also had increased energy and activity, and 61% had irritability prior to diagnosis, as well.

Racing Thoughts in Depression

Racing thoughts also can occur with depression. Researchers have characterized racing thoughts in depression as more "crowded thoughts," and noted they are not as pleasant to experience as racing thoughts in mania and hypomania.

Some clinicians believe that depression combined with racing/crowded thoughts may actually represent a disorder that's closely related to bipolar disorder — on the "bipolar spectrum."

One 2005 study involving 379 people with bipolar II disorder and 271 people with major depressive disorder found that 56% of those with depression also had racing thoughts.

Those with depression and racing thoughts had some common characteristics: they were diagnosed at a younger age, their episodes of depression were more severe, and their disorder was more psychotic in nature. In addition, they tended to have more family history of bipolar disorder.

Sources:

Benazzi F. Depression with racing thoughts. Psychiatry Research. 2003 Oct 15;120(3):273-82.

Benazzi F. Unipolar depression with racing thoughts: a bipolar spectrum disorder? Psychiatry and Clinical Neurosciences. 2005 Oct;59(5):570-5.

Correll CU et al. Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode. Bipolar Disorders. 2014 Aug;16(5):478-92.

Homish GG et al. Predictors of later bipolar disorder in patients with subthreshold symptoms. Journal of Affective Disorders. 2013 Jan 10;144(1-2):129-33.

Piguet C et al. Phenomenology of racing and crowded thoughts in mood disorders: a theoretical reappraisal. Journal of Affective Disorders. 2010 Mar;121(3):189-98.

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