Cyclothymia

Cyclothymia is a mental illness that causes periods of low mood and elevated mood that can be disruptive to daily life and normal functioning.

It can be tough to diagnose because it is not common and is similar to other conditions. When diagnosed correctly, treatments for cyclothymia that include appropriate therapies can help individuals manage moods and minimize symptoms.

Cyclothymia, more officially known as cyclothymic disorder, is a type of mental illness and mood disorder that is similar to bipolar disorder. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the guide used by mental health professionals to make diagnoses, it is categorized as a bipolar related disorder. Cyclothymia is not common, and it is characterized by high and low mood swings that are less severe than the cycles of depression and mania experienced by someone with bipolar disorder.

• Only about 0.4 percent of the population is diagnosed with cyclothymia.
• The risk of someone with cyclothymia eventually developing bipolar disorder is estimated to be anywhere between 15 and 50 percent.
• The first signs of cyclothymia are usually seen during childhood or the teenage years.
• Cyclothymia can be difficult to diagnose and is often not diagnosed until years or decades after the first signs.
• Some researchers believe cyclothymia is related more to neurological development and personality than to bipolar disorder.

According to the DSM-5, cyclothymia causes at least two years of periodic hypomanic and depressive symptoms. The hypomanic symptoms do not meet the criteria for mania, a characteristic mood of bipolar disorder, and the depressive symptoms are not severe or long-lasting enough to meet the criteria for major depression. There is no break in the symptoms for longer than two months. Hypomanic symptoms include:

• A feeling of euphoria, or extreme well-being
• An inflated sense of self-confidence
• A drive to do or achieve more
• Rapid talking
• Racing thoughts
• Increased energy and decreased need for sleep
• Increased activity levels
• Difficulty concentrating, distractibility
• Poor judgment and risk-taking behaviors
• Irritability or agitation

Depressive symptoms include:

• Feelings of sadness and hopelessness
• Feeling guilty, worthless, or ashamed
• Crying a lot
• Fatigue and inactivity
• Loss of interest in activities
• Changes in eating habits and weight
• Irritability
• Difficulty sleeping or sleeping too much
• Difficulty focusing, feeling restless
• Thoughts of suicide and death

The symptoms of cyclothymia are not as severe as those caused by bipolar disorder, although they are similar. Someone with cyclothymic disorder can generally function normally but have some challenges because of the mood shifts.

It is common for someone diagnosed with a mental illness to have other mental health disorders. A review of several studies of cyclothymic disorder found that some of the most common co-occurring disorders and complications with this mental illness are anxiety disorders, personality disorders, substance use disorders, and poor impulse control.

Suicidal thoughts or behaviors may also be complications of cyclothymia, especially when it is left untreated. Cyclothymic disorder may also develop into bipolar disorder, but with long-term, effective treatment it is possible to lower this risk or prevent the mood episodes from becoming more severe and turning into full mania or major depression.

The fact that cyclothymia is not as severe as bipolar disorder should not dissuade anyone from getting treatment. Treatment can help stabilize moods, improve quality of life, and help individuals function better in all areas of their lives. Diagnosis may include a physical exam, a psychological evaluation, and keeping track of moods and symptoms to find a pattern.

With a diagnosis, treatment can begin and should be expected to be lifelong to manage the condition, although it may vary in frequency depending on symptoms and episodes. There are no medications specifically approved to treat cyclothymia, but mood stabilizers used for bipolar may also be used for patients with cyclothymia.

More important to treatment is ongoing therapy. Cognitive behavioral therapy is used to help patients be more aware of their moods and what triggers changes in mood, and to learn strategies for coping with those shifts and for changing negative thoughts and behaviors. Other types of therapy can help a patient learn how to create a routine and make healthy lifestyle choices to stabilize moods. Ongoing treatment is crucial for managing cyclothymia because, even when symptoms seem to have disappeared, relapse is possible.