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Cyclothymia (cyclothymic disorder)By Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/cyclothymia/DS00729
Cyclothymia (si-klo-THIGH-me-uh), also called cyclothymic disorder, is a mood disorder. Cyclothymia causes emotional ups and downs, but they're not as extreme as in bipolar disorder type I or II.
With cyclothymia, you experience periods when your mood noticeably shifts up and down 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 I or II, 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 I or II. Treatment options for cyclothymia include talk therapy (psychotherapy), medications and close, ongoing follow-up with your doctor.
Cyclothymia symptoms alternate between emotional highs and lows. The highs of cyclothymia are characterized by symptoms of an elevated mood (hypomanic symptoms), which resemble those of mania but are less severe. The lows consist of mild or moderate depressive symptoms.
Cyclothymia symptoms are similar to those of bipolar disorder I or II, 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.
Hypomanic phase of cyclothymia
The highs (hypomania) of cyclothymia meet the same diagnostic definition of hypomania for type II bipolar disorder. Signs and symptoms may include:
- An exaggerated feeling of happiness or well-being (euphoria)
- Extreme optimism
- Inflated self-esteem
- Poor judgment
- Rapid speech
- Racing thoughts
- Aggressive or hostile behavior
- Being inconsiderate of others
- Excessive physical activity
- Risky behavior
- Spending sprees
- 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 cyclothymia
Depressive episodes of cyclothymia may include a combination of these signs and symptoms:
- Suicidal thoughts or behavior
- Sleep problems
- Appetite problems
- Loss of interest in activities once considered enjoyable
- Decreased sex drive
- Problems concentrating
- Chronic pain without a known cause
For the first two years after symptoms begin, the highs and lows of cyclothymia are less extreme. After that time, your highs and lows may become more pronounced. You may have depressive episodes that meet the criteria for full-blown major depressive episodes. Or you could experience full manic episodes.
When to see a doctor
If you have any symptoms of cyclothymia, seek medical help as soon as possible. Cyclothymia generally doesn't get better on its own. If you're reluctant to seek treatment, work up the courage to confide in someone who can help you take the first steps.
If a loved one has symptoms of cyclothymia, talk openly and honestly with that person about your concerns. You can't force someone to seek professional help, but you can offer support and help find a qualified doctor or mental health provider.
Although suicidal thoughts might occur with cyclothymia, they're more likely to occur if you have bipolar disorder I or II. If you're considering suicide right now:
- Call 911 or your local emergency services number, or go to a hospital emergency department.
- Call a local crisis center or suicide hotline number — in the United States, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
If you just can't make that call, reach out to someone else — immediately — such as your doctor, mental health provider, family member, friend or someone in your faith community.
It's not known specifically what causes cyclothymia. As with many mental health 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
Cyclothymia is thought to be relatively rare. But true estimates are hard to pin down because people may be undiagnosed or misdiagnosed as having other mood disorders, such as depression.
Cyclothymia typically starts during teenage years or young adulthood. The condition affects about the same number of males and females.
Left untreated, cyclothymia can result in significant emotional problems that affect every area of your life — and it might develop into bipolar disorder I or II, based on worsening or more-extreme signs and symptoms.
Preparing for your appointment
If you have signs and symptoms common to cyclothymia, call your doctor. After your initial appointment, your doctor may refer you to a mental health provider who can help make a firm diagnosis and create the right treatment plan for you.
Here's some information on how to prepare for your appointment and what to expect from your doctor.
What you can do
- Write down any symptoms you've been experiencing, and for how long.
- Write down your medical information, including other physical or mental health conditions with which you've been diagnosed.
- Make a list of any medications you're taking, including over-the-counter medications, vitamins and supplements.
- Ask a trusted family member or friend to come to your appointment, if possible. Someone close to you may provide additional insight about your condition and can help you remember what's discussed during your appointment.
- Write down questions to ask your doctor.
Questions to ask at your first appointment
- What do you believe is causing my symptoms?
- Are there any other possible causes?
- How will you determine my diagnosis?
- Should I see a mental health specialist?
Questions to ask if you're referred to a specialist
- What is my diagnosis?
- What treatments are likely to be helpful in my case?
- How much do you expect my symptoms to improve with treatment?
- Will I need to be treated for the rest of my life?
- What lifestyle changes can help me manage my symptoms?
- How often should I be seen for follow-up visits?
- Am I at increased risk of other mental health problems?
- Do you have printed material that I can take home with me? What websites do you recommend?
Don't hesitate to ask for more information if you don't understand something.
What to expect from your doctor
A doctor or mental health provider may ask:
- What prompted you to seek treatment?
- How would you describe your symptoms?
- How have the people close to you described your symptoms?
- When did you or your loved ones first notice these symptoms?
- Have your symptoms been getting better or worse over time?
- If you have intense high and low periods, how long do these periods generally last?
- Do you also have periods where your mood feels relatively stable?
- How would you describe your mental and emotional state during high versus low periods? How would your loved ones answer this question about you?
- How would you say your choices and behaviors change during high versus low periods? How would your loved ones answer this question about you?
- Do your physical needs change during high versus low periods, such as your need for sleep, food or sex?
- How are these cycles affecting your life, including work, school and relationships?
- Have any of your close relatives had similar symptoms?
- Have you been diagnosed with any medical conditions?
- Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?
- Have you ever thought about harming yourself or others?
- Do you drink alcohol or use illegal drugs? If so, how often?
Tests and diagnosis
Your doctor or other health care provider must determine if you have cyclothymia, bipolar disorder I or II, depression or another condition that may be causing your symptoms. To help pinpoint a diagnosis for your symptoms, you'll likely have several exams and tests, which generally include:
- General medical exam. During this exam, your doctor measures your blood pressure and listens to your heart and lungs, among other things — or reviews results of recent physical exams — to determine if there could be any medical reasons for your symptoms.
- Lab tests. These may include a complete blood count 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.
Diagnostic criteria for cyclothymia
To be diagnosed with cyclothymia, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Diagnostic criteria for cyclothymia include those below.
- You've had numerous periods of elevated mood (hypomania) and many periods of depressive symptoms for at least two years.
- Your periods of stable moods usually last less than two months.
- Your symptoms significantly affect you socially, at work, at school or in other important functions.
- You don't have manic episodes, major depression or schizoaffective disorder — a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as mania or depression.
- Your symptoms aren't caused by substance abuse or a medical condition.
Treatments and drugs
Cyclothymia requires lifelong treatment — even during periods when you feel better — usually guided by a mental health provider skilled in treating the condition.
To treat cyclothymia, your doctor or mental health provider aims to:
- Decrease your risk of bipolar disorder I or II, since cyclothymia carries a high risk of developing into more severe bipolar disorder
- Reduce the frequency and severity of your symptoms, allowing you to live a more balanced and enjoyable life
- Prevent a relapse of symptoms, through continued treatment during periods of remission (maintenance treatment)
- Treat alcohol or other substance abuse problems, since they can worsen cyclothymia symptoms
The main treatments for cyclothymia are medications and psychotherapy.
Medications may help control cyclothymia symptoms and prevent episodes of hypomania and depression. Medications used to treat cyclothymia include:
- Mood stabilizers. Mood stabilizers help regulate and stabilize mood so that you don't swing between depression and hypomania. Lithium (Lithobid) has been widely used as a mood stabilizer. Anti-seizure medications, also known as anticonvulsants, are also used to prevent mood swings. Examples include valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal). Your doctor may recommend that you take mood stabilizers for the rest of your life to prevent and treat hypomanic episodes.
- Antipsychotics. Certain antipsychotic medications — such as olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) — may help people who don't benefit from the mood-stabilizing effects of anti-seizure medications.
- Anti-anxiety medications. Anti-anxiety medications, such as benzodiazepines, may help improve sleep.
- Antidepressants. Use of antidepressants for cyclothymia is typically not recommended, unless they're combined with a mood stabilizer or antipsychotic. As with bipolar disorder I or II, 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.
All medications have side effects and possible health risks. Talk to your doctor about the benefits and risks.
Medications such as mood stabilizers 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, 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. Cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. In addition, you can explore what triggers your hypomanic or depressive episodes and learn how to manage stress and cope with upsetting situations.
- Family therapy. Family therapy helps you and your family members learn how to communicate, solve problems and resolve conflicts with each other. Family therapy helps identify stressors within the family that may contribute to unhealthy behavior patterns. Your family may also gain a better understanding of 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.
- Interpersonal social rhythm therapy. This type of therapy helps you manage your daily routines (including your sleep schedule), improve your relationships and develop better communication skills so that interpersonal problems don't disrupt your routines.
Lifestyle and home remedies
You can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these lifestyle and self-care steps for cyclothymia:
- Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, cyclothymia signs and symptoms are likely to come back.
- Pay attention to warning signs. You may have identified a pattern to your cyclothymia episodes and what triggers them. Call your doctor if you feel you're facing an episode. Involve family members or friends in watching for warning signs. Addressing symptoms early on can prevent episodes from becoming full-blown.
- Quit drinking or using illegal drugs. Alcohol and illegal drugs may trigger mood changes. Get help if you have trouble quitting on your own.
- Check first before taking other medications. Call the doctor who's treating you for cyclothymia before you take medications prescribed by another doctor. Sometimes other medications trigger episodes of cyclothymia or may interfere with medications you're already taking.
- Keep a record. Track your moods, daily routines and significant life events. These records may help you and your mental health provider understand the effect of treatments and identify thinking patterns and behaviors associated with cyclothymic symptoms.
Coping and support
Coping with cyclothymia can be difficult. Medications can have unwanted side effects, and you may feel angry or resentful about having a serious condition that requires lifelong treatment. During periods when you feel better, or during hypomanic episodes, you may be tempted to stop your cyclothymia treatment. Here are some ways to cope with cyclothymia:
- Learn about the disorder. Learning about cyclothymia and its possible complications can empower you and motivate you to stick to your treatment plan.
- Join a support group. Support groups for people with cyclothymia can help you reach out to others facing similar challenges.
- Stay focused on your goals. Successfully managing cyclothymia can take time. Stay motivated by keeping your goals in mind.
- Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
- Learn relaxation and stress management. Try stress-reduction techniques such as meditation, yoga or tai chi.
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.
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