Cyclothymia (si-kloh-THIGH-me-uh), also called cyclothymic disorder, is a mild form of bipolar disorder. Like bipolar disorder, cyclothymia is a chronic mood disorder that causes emotional ups and downs. With cyclothymia, you experience periods when your mood noticeably fluctuates from your baseline. You may feel on top of the world for a time, followed by a low period when you feel somewhat blue. Between these cyclothymic highs and lows, you may feel stable and fine. Compared with bipolar disorder, the highs and lows of cyclothymia are less extreme. Still, it's critical to seek help managing these symptoms because they increase your risk of bipolar disorder. Treatment options for cyclothymia include psychotherapy, medications, and — most important — close, ongoing follow-up with your doctor.
Complications of Cyclothymic Disorder
Left untreated, cyclothymia can result in significant emotional problems that affect every area of your life. In addition, cyclothymia significantly increases your risk of developing bipolar disorder.
Causes of Cyclothymic Disorder
It's not known specifically what causes cyclothymia. As with many mental disorders, research shows that it may result from a combination of:
Heredity — cyclothymia tends to run in families
Your body's biochemical processes, such as changes in brain chemistry
Signs & Symptoms of Cyclothymic Disorder
Cyclothymia symptoms include an alternating pattern of emotional highs and lows. The highs of cyclothymia are characterized hypomanic symptoms, which resemble those of mania, but are less severe. The lows consist of mild or moderate depressive symptoms. Cyclothymia symptoms are generally similar to those of bipolar disorder, but they're less severe. When you have cyclothymia, you can typically function in your daily life, though not always well. The unpredictable nature of your mood shifts may significantly disrupt your life because you never know how you're going to feel — and you can't just will yourself to live life on an even keel.
Hypomanic phase of cyclothymic disorder
Signs and symptoms of hypomanic episodes of cyclothymia may include:
Unusually good mood or cheerfulness (euphoria)
Aggressive or hostile behavior
Being inconsiderate of others
Increased physical activity
Increased drive to perform or achieve goals
Increased sexual drive
Decreased need for sleep
Tendency to be easily distracted
Inability to concentrate
Depressive phase of cyclothymic disorder
Signs and symptoms of depressive episodes of cyclothymia may include:
Suicidal thoughts or behavior
Loss of interest in daily activities
Decreased sex drive
Chronic pain without a known cause
Diagnosis of Cyclothymic Disorder
To help pinpoint a diagnosis for your symptoms, you'll likely have several exams and tests. Your doctor or other health care provider must determine if you have cyclothymia, bipolar disorder, depression or another condition that may be causing your symptoms.
These exams and tests generally include:
Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
Laboratory tests. These may include a complete blood count (CBC) as well as thyroid tests and other blood tests. You may also have a urinalysis or tests for drug and alcohol use.
Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. You may also fill out psychological self-assessments and questionnaires. You may be asked about substance or alcohol abuse. And with your permission, family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression.
Treatments of Cyclothymic Disorder
Cyclothymia is a long-term condition that requires lifelong treatment, even during periods when you feel better. Cyclothymia treatment is usually guided by a mental health provider skilled in treating the condition. Because cyclothymia has a high risk of developing into bipolar disorder, it's important to get effective and appropriate treatment. Treatment is also vital for reducing the frequency and severity of hypomanic and depressive episodes and allowing you to live a more balanced and enjoyable life. Maintenance treatment — continued treatment during periods of remission — is also important. If you skip maintenance treatment, you may be at higher risk of having a relapse of cyclothymia symptoms or having minor episodes turn into larger problems. If you have problems with alcohol or substance abuse, you must get treatment for those, too, since they can worsen cyclothymia symptoms. The main treatments for cyclothymic disorder are medications and psychotherapy.
Medications may help control cyclothymia symptoms and prevent episodes of hypomania and depression. Medications commonly used to treat cyclothymia include:
Mood stabilizers. Mood stabilizers are the most commonly prescribed medications for cyclothymic disorder. These medications help regulate and stabilize mood so that you don't swing between depression and hypomania. Lithium (Eskalith, Lithobid) has been widely used as a mood stabilizer and is generally the first line of treatment for hypomanic episodes. Your doctor may recommend that you take mood stabilizers for the rest of your life to prevent and treat hypomanic episodes.
Anti-seizure medications. The medications, also known as anticonvulsants, are used to prevent mood swings. They include valproic acid (Depakene), divalproex sodium (Depakote) and lamotrigine (Lamictal).
Other medications. Certain atypical antipsychotic medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), may help people who don't benefit from anti-seizure medications. Anti-anxiety medications, such as benzodiazepines, may help improve sleep. In addition, one medication, quetiapine (Seroquel), has been approved by the Food and Drug Administration to treat both the manic and depressive episodes of bipolar disorder and may also be helpful for cyclothymic disorder.
Antidepressants. Use of antidepressants in cyclothymic disorder is typically not recommended, unless they're combined with a mood stabilizer. As with bipolar disorder, taking antidepressants alone can trigger potentially dangerous manic episodes. Before taking antidepressants, carefully weigh the pros and cons with your doctor. If one medication doesn't work well for you, there are many others to consider. Keep trying until you find one that works well for you. Your doctor may advise combining certain medications for maximum effect. It can take several weeks after first starting a medication to notice an improvement in your cyclothymia symptoms. Be aware that all medications have side effects and possible health risks. Certain antipsychotic medications, for instance, may increase the risk of diabetes, obesity and high blood pressure. If you take these medications, talk to your doctor about being monitored for health problems. Also, mood-stabilizing medications may harm a developing fetus or nursing infant. Women with cyclothymic disorder who want to become pregnant or do become pregnant must fully explore with their health care providers the benefits and risks of medications.
Psychotherapy is another vital part of cyclothymia treatment. Psychotherapy, also called counseling or talk therapy, can help you understand what cyclothymia is and how it's treated.
Types of therapy that may help cyclothymia include:
Cognitive behavioral therapy. This is a common form of individual therapy for cyclothymia. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. In addition, you can explore what may trigger your hypomanic or depressive episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
Family therapy. Family therapy involves you and your family members. Family therapy can help identify and reduce stressors within your family that may contribute to unhealthy behavior patterns. Family therapy can also help your family improve its communication style and problem-solving skills and resolve conflicts. And it may help your family — whether parents, siblings or partners — better understand your condition and why you think and behave the way you do.
Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.
Social rhythm therapy. This type of therapy helps you manage your daily routines, including your sleep schedule, and improve your relationships so that interpersonal problems don't disrupt your routines.
Prevention of Cyclothymic Disorder
There's no sure way to prevent cyclothymia. However, treatment at the earliest indication of a mental health disorder can help prevent cyclothymia from worsening. Long-term preventive treatment also can help prevent minor episodes from becoming full-blown episodes of mania or depression.
When to seek Medical Advice
If you have any symptoms of cyclothymia, seek medical help as soon as possible. Cyclothymic disorder generally doesn't get better on its own. If you're not sure where to start with treatment, see your primary health care provider. He or she may refer you to a mental health provider with experience in cyclothymia or bipolar disorder.
If you're reluctant to seek treatment, try to work up the courage to confide in someone, whether it's a friend or loved one, a health care professional, a faith leader, or someone else you trust. He or she can help you take the first steps to successful treatment.
If you have a loved one you think may have symptoms of cyclothymia, have an open and honest discussion about your concerns. You can't force someone to seek professional help, but you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider.