Cyclothymia, or cyclothymic disorder, is a mild mood disorder with symptoms similar to bipolar II disorder. Both cyclothymia and bipolar disorder cause emotional ups and downs, from manic highs to depressive lows.
Cyclothymia is characterized by fluctuating low-level depressive symptoms along with periods of mild mania (hypomania). Symptoms must be present for at least two years before a diagnosis of cyclothymia may be made (one year in children). These changes in mood tend to occur in cycles, reaching highs and lows. In between these highs and lows, you may feel like your mood is stable.
The main difference between the two disorders is intensity. The mood swings associated with cyclothymia are not as extreme as those that come with bipolar disorder: Those with bipolar disorder experience intense symptoms that meet clinically criteria for the diagnoses of mania and major depression, while those with cyclothymia experience milder “ups and down,” described as hypomania and mild depression. If left untreated, cyclothymia can increase your risk of developing bipolar disorder.
The condition usually develops in adolescence. People with the disease often appear to function normally, although they may seem "moody" or "difficult" to others. People will often not seek treatment because the mood swings do not seem severe. People with cyclothymia may occasionally even be hyper-productive.
According to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-V), cyclothymia is distinguished from bipolar disorder because it lacks the full criteria of major depression, mania, or a mixed episode disorder. However, some people with cyclothymia will develop bipolar I or bipolar II disorder later in life.
People with cyclothymia usually experience many weeks of low-level depression followed by an episode of mild mania that lasts several days.
Depressive symptoms of cyclothymia may include:
- insomnia or hypersomnia (sleeping too much)
- changes in appetite
- weight loss or gain
- fatigue or low energy
- low sexual desire and function
- feelings of hopelessness, worthlessness, or guilt
- inattentiveness, lack of concentration, or forgetfulness
- unexplained physical symptoms
The manic symptoms of cyclothymia may include:
- extremely high self-esteem
- excessive talking or speaking very quickly, sometimes so fast others have trouble following what the person is saying
- racing thoughts (muddled and disorganized)
- lack of focus
- restlessness and hyperactivity
- increased anxiety
- going for days with little or no sleep (without feeling tired)
- reckless or impulsive behavior
Some patients experience "mixed periods," in which a combination of both manic and depressed symptoms occur within a very short time — one followed immediately by the other.
Researchers are not sure what causes or triggers symptoms of cyclothymia. The condition is, however, known to run in families.
A person does not have cyclothymia if they feel symptom-free for more than two months. To distinguish cyclothymia from regular moodiness, your doctor will compare your symptoms to the following clinical criteria:
- many periods of elevated mood (hypomania) and depression for at least two years (one year in children and teens) occurring at least half of the time
- periods of stable moods lasting less than two months
- symptoms that socially impact your daily life — at school, work, etc.
- symptoms that don’t meet the criteria for bipolar disorder, major depression or another mental disorder
- symptoms not caused by substance abuse or another medical condition
Your doctor will discuss your symptoms and medical history with you. He/she may also ask you questions about your use of drugs or alcohol.
Lab tests may also be performed to rule out other medical conditions that may be causing the symptoms.
Cyclothymia is a chronic condition that will require lifelong treatment. If you stop taking medications — even during periods of remission — your symptoms will return.
Because cyclothymia may develop into bipolar disorder, it is crucial that you receive appropriate treatments. Alcohol and drug use may increase your symptoms as well.
The main types of medications used to treat cyclothymia include:
- mood stabilizers such as lithium
- anti-seizure medications (also known as anticonvulsants) include divalproex sodium (Depakote), amotrigine (Lamictal), and valproic acid (Depakene)
- atypical antipsychotic medications such as olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) may help patients who don't respond to anti-seizure medications
- anti-anxiety medications such as benzodiazepine
- antidepressants should only be used in conjunction with a mood stabilizer as they may cause potentially harmful manic episodes when taken on their own
Psychotherapy is considered a vital part of the treatment of cyclothymia. The two primary types of psychotherapy used to treat cyclothymia are cognitive behavior therapy and well-being therapy.
Cognitive behavioral therapy focuses on identifying negative or unhealthy beliefs and behaviors and replacing them with positive or healthy ones. It may also help you manage stress and develop coping techniques.
Well-being therapy focuses on improving overall quality of life rather than fixing specific psychological symptoms. One recent clinical study found that a combination of cognitive behavioral therapy and well-being therapy bring significant improvements to the lives of patients with cyclothymia.
Other types of therapy that may benefit patients include talk, family, or group therapy.
There is no cure for cyclothymia, but there are treatments that will help you manage your symptoms. Your doctor will help you create a treatment plan that will most likely include a combination of medication and therapy.
It can be tempting to stop taking your medication or attending therapy sessions during episodes of hypomania. But it’s very important that you stick with your treatment plan.