Cyclothymia

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Cyclothymia
Cyclothymic Personality Symptoms, Causes, and Treatment

By Arnold Lieber, MD

Signs & Symptoms Causes Diagnosis Treatments Lifestyle
What is Cyclothymia?

Most people have heard of bipolar disorder (manic depressive disorder), where individuals experience cycles of highs and lows (mania and depression). But, what is cyclothymia (cyclothymic disorder)? Cyclothymia is a rare mood disorder which has similar characteristics of bipolar disorder, just in a milder and more chronic form. If you are suffering from cyclothymia, you experience cyclic highs and lows that are persistent for at least two years or more. With cyclothymic disorder, your lows are a mild depression – not characteristic of full major depression. Your highs are classified as symptomatic of hypomania – a less severe form of mania. During your highs, your mood elevates for a time before returning to its baseline. During your lows you feel mildly depressed. In between your elevated and depressed moods, you are likely to feel like yourself.

Everyone has their ups and downs, right? What distinguishes cyclothymia from regular mood swings? Cyclothymia can increase your chances of developing bipolar disorder (estimates vary widely from a 15% to 50% increased risk of being diagnosed with bipolar disorder if suffering from cyclothymia) and your highs and lows interfere with your daily life functions and relationships – so it’s essential to seek treatment to get a handle on the disorder before it becomes fully disruptive.

It is estimated that the rate of occurrence of cyclothymia in the general population is between 0.4% to 1%, with it equally affecting men and women. Though, women are more likely to seek treatment. While typical onset of the disorder occurs during adolescence, its onset is consistently hard to identify. Risk of suffering from Attention-Deficient/Hyperactivity Disorder, substance abuse, and sleep disorders are elevated among individuals suffering from cyclothymic disorder.
What are the Symptoms?

The standard diagnostic criteria from the American Psychiatric Association states that to be diagnosed with cyclothymia, you must meet all of the following:

Multiple periods of hypomanic symptoms that do not meet criteria for a hypomanic episode and multiple periods of depressive symptoms that do not meet criteria for a major depressive episode for at least two years (one year for children and adolescents)
Throughout the two year (one for children and adolescents) time frame, symptoms of hypomania and depression have been present for at least half the time, with no more than two consecutive months showing no symptoms
Criteria for a major depressive episode, manic episode, or hypomanic episode have never been met
Other mental disorders (e.g., schizoaffective disorder, schizophrenia, delusional disorder) have been ruled out as the the contributing factor to hypomanic and depressive symptoms
Hypomanic and depressive symptoms are not related to medications, substance abuse, or other medical conditions
Hypomanic and depressive symptoms cause significant disruption in social, occupational, or other functional areas

If you or someone you know is suffering from cyclothymia, depressive signs and symptoms may include the following:

Feelings of sadness, emptiness, and hopelessness
Irritability
Feeling tearful
Sleep disturbances – sleeping much more or much less than usual
Restlessness
Feelings of worthlessness and guilt
Fatigue
Concentration problems
Suicidal thoughts
Loss of interest in activities once considered pleasurable
Weight changes – due to eating much more or much less than usual
Lack of motivation
Impaired judgment, planning, or problem-solving abilities
Low self-esteem
Pessimism
Loneliness
Submissiveness
Social withdrawal
Difficulty handling conflict
Lacking meaning and purpose in life

If you or someone you know is suffering from cyclothymia, hypomanic signs and symptoms may include the following:

Euphoric state – exaggerated sense of well-being and happiness
Inflated self-esteem
Inflated optimism
Irritability and agitation
Decreased need for sleep
Racing thoughts
Poor judgment resulting in risky behaviors
Talking more than usual
Excessive physical activity
Easily distracted
Concentration problems
Increased drive to perform or reach goals
Hyperactivity – inability to sit still
Emotional instability – overreacting to events
Reckless thrill seeking (e.g., gambling, sports)
Impulsivity
Irresponsibility

What are the Causes and Risk Factors?

Like most mental health disorders, the exact cause of cyclothymia is unknown. However, the genetic component of cyclothymia is strong. For cyclothymia, major depression, and bipolar mood disorders, a family history indicates a greater risk of development. Twin studies suggest that the risk of developing cyclothymia is 2-3 times more likely if an identical twin is diagnosed with the disorder, pointing to the strong genetic component of the mood disorder.

Environmental factors are also a likely contributing factor to being diagnosed with cyclothymia. As with bipolar disorder and major depression, certain life events may increase your chances of developing cyclothymia. These include things like physical or sexual abuse or other traumatic experiences and prolonged periods of stress.
Cyclothymia Tests and Diagnoses

If you think you might be suffering from cyclothymia, seek the help of your medical doctor or mental health provider. Your doctor will likely perform a series of tests to make sure the causes of your depressive and hypomanic symptoms are not due to an underlying medical condition or medication you are taking.

Your mental health provider will perform a series of assessments to diagnose the occurrence of cyclothymia, with the ultimate diagnosis being made on your mood history. During your psychological evaluation, the doctor will ask about your family history of mood disorders and might ask you to complete a daily diary of your moods to indicate mood swings that occur during a typical day.
Treatment Options

Medications and psychotherapy are the common treatment options prescribed to patients living with cyclothymia. Treatment is usually a chronic, lifelong process, with the aim to decrease your depressive and hypomanic symptoms and to decrease your risk of developing bipolar disorder.

Currently, there are no known medications that can effectively treat cyclothymia, though, your doctor may prescribe commonly used medications known to treat bipolar disorder to ease your symptoms and reduce their frequency. Commonly prescribed drug treatments include the use of anticonvulsants and atypical antipsychotics – such as Lithium and Quetiapine. Antidepressants have not been shown to be effective in the treatment of cyclothymia.

More research is needed to successfully conclude the benefits of psychotherapy, or talk therapy, in the treatment of cyclothymia. However, some of the common methods used to treat bipolar disorder are also used in the treatment of cyclothymia, including:

Cognitive Behavioral Therapy (CBT) – a focus on changing negative thoughts and beliefs into positive ones; stress management techniques; identification of trigger points
Dialectical Behavioral Therapy (DBT) – teaches awareness, distress tolerance, and emotional regulation
Interpersonal and Social Rhythm Therapy (IPSRT) – a focus on the stabilization of daily rhythms – especially related to sleep, wake, and mealtimes; routines being indicative of helping stabilize moods

Living with Cyclothymia

Less than half of individuals living with cyclothymia develop bipolar disorder. In most, cyclothymia is a chronic disorder that remains prevalent throughout the lifetime. In others, cyclothymia seems to dissipate and resolve itself over time.

The effects of cyclothymia can be detrimental to social, family, work, and romantic relationships. In addition, the impulsivity associated with hypomanic symptoms can lead to poor life choices, legal issues, and financial difficulties. Research has also shown that if you are suffering from cyclothymic disorder, you are more likely to abuse drugs and alcohol.

To decrease the negative effects of cyclothymia on your daily life, take your medications as directed, do not use alcohol or take recreational drugs, track your moods to provide helpful information to your mental health provider about the effectiveness of treatment, get plenty of sleep, and exercise regularly.