Cyclothymia, also referred to as cyclothymic disorder, is a rare and relatively mild mood issue. It is characterized by emotional highs and lows. Cyclothymia may interfere with a person’s relationships or ability to function at school or work.
Cyclothymic Disorder: What Does It Mean?
Cyclothymia is a mood disorder that involves spells of high and low moods. During an elevated mood, the individual may feel strong, positive, and motivated. However, the elevated mood does not meet the criteria for a hypomanic episode.
A downward shift in mood may cause a person with cyclothymia to feel low, gloomy, irritable, and incapable of having fun. However, the lowered mood does not meet the criteria for a major depressive episode.
Individuals with cyclothymia may feel stable in between the emotional ups and downs that characterize the condition. As the symptoms are not extremely debilitating, it may be difficult for some people to recognize they have a mental health concern. Family members are often first to notice something is wrong and recommend professional care.
What is a Hypomanic Episode?
A hypomanic episode is an overactive state that impacts a person’s mood, thoughts, and behavior. During this period the individual may be excessively happy, irritable, flamboyant, or daring. Specific symptoms vary from one person to another.
To meet the diagnostic criteria for hypomania an individual must have an elevated mood, increased activity, and symptoms of the condition for most of the day, for at least four days.
What is Dysthymia?
Dysthymia is a mild but persistent form of depression. People with dysthymia tend to lose interest in everyday activities, complain more, feel less productive, feel inadequate, and have low self-esteem.
Symptoms may come and go for several years. However, symptoms of dysthymia are not as severe as symptoms of major depression.
Stats: How Many Suffer from this Disorder?
Cyclothymia affects 0.4% to 1% of people in the United States. At a mental health facility, 3% to 5% of the population may have cyclothymia.
Cyclothymia affects men and women equally. However, women are more likely to seek professional assistance than men.
What Causes Cyclothymia?
The specific causes of cyclothymia are unknown. Research shows a combination of various factors may play a role in the onset of the condition. These include:
Genetics
There is a higher prevalence of cyclothymic disorder among people who have relatives with the condition. Twin studies indicate people are 2 to 3 times more likely to develop cyclothymic disorder if an identical twin is diagnosed with the condition.
Environment
Trauma, sexual abuse, physical abuse, or chronic stress may increase the likelihood of developing cyclothymia.
Neurobiology
Changes in the brain’s neurobiology may help trigger the condition
Signs and Symptoms of Cyclothymic Disorder
People with cyclothymia have irregular, unpredictable fluctuations in mood. These highs and lows may last for several days or weeks, with a month of stable emotions in between. Individuals may also experience a continuous cycle from elation to mild depression with no stable period in between.
Hypomanic symptoms of cyclothymia include:
- Excessive self-esteem
- Extreme happiness
- Excessive optimism
- Racing thoughts
- Lack of focus
- Increased risk-taking
- Poor decision-making
- Increased talkativeness
- Lack of sleep
Depressive symptoms of cyclothymia include:
- Hopelessness
- Loneliness
- Melancholy
- Worthlessness
- Guilt
- Social isolation
- Sudden weight loss or gain
- Fatigue
- Lack of motivation
- Inability to concentrate
- Restlessness
- Sleep issues
- Suicidal ideation
What are the Common Behaviors/Characteristics?
Cyclothymia may lower a person’s quality of life. The depressive symptoms are typically more frequent, unpleasant, and disabling than the hypomanic symptoms. It is usually an inability to cope with the depressive symptoms that prompts individuals to seek treatment.
Individuals with cyclothymia may have substance use and sleep issues. Children with the condition are more likely to have attention deficit hyperactivity disorder (ADHD) than their peers.
Testing: What are the Diagnostic Criteria Per the DSM 5?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides the following criteria for a diagnosis of cyclothymia:
- For at least 2 years (1 year for children and teenagers), there have been numerous periods of hypomanic symptoms that do not meet the full criteria for a hypomanic episode and numerous periods of depressive symptoms that do not meet the full criteria for a major depressive episode
- The symptoms have been present for at least half that time
- Stable mood usually lasts no more than two months
- Symptoms do not meet the criteria for bipolar disorder, mania, hypomania, major depression, or other mental disorders
- Symptoms are not due to a medical condition or substance use
- Symptoms cause significant distress at work, school, or in other areas of functioning
If anxiety is a significant factor, a clinician may add the specifier “with anxious distress” to a diagnosis of cyclothymic disorder.
Cyclothymic Disorder and Other Conditions
Cyclothymia has symptoms that are similar to other mood disorders such as dysthymia (persistent depressive disorder) and bipolar disorder. However, there are factors that distinguish cyclothymic disorder from these related issues.
Cyclothymic Disorder vs Persistent Depressive Disorder
Persistent depressive disorder is characterized by a prolonged period of low mood. In essence, it is a mild, chronic form of depression. While cyclothymia does have periods of low mood, there is a continuous cycle between low moods and elevated moods. The presence of hypomanic symptoms or elevated moods may help to differentiate between persistent depressive disorder and cyclothymia.
Cyclothymic Disorder vs Bipolar Disorder
People with bipolar disorder also experience cycling between high and low moods. However, the highs and lows in bipolar disorder are more severe and more frequent than those in cyclothymic disorder. Bipolar disorder is also more prevalent than cyclothymia as it (bipolar disorder) affects 2.6% of the American population.
Related Conditions
Cyclothymia is related to other issues such as clinical depression, hypomania, mania, and borderline personality disorder.
Cyclothymic Disorder In Adults/Children
Cyclothymia may affect children, teenagers, or adults. Onset usually occurs in late adolescence or early adulthood. Hypomanic and depressive symptoms should be observable for one year before a child or teenager can be diagnosed with the condition. For adults, the observational period is two years.
Example Case of Cyclothymia
Marco, 25, schedules an appointment with a nearby psychiatrist after his wife declares he is no longer the person she married. Marco tells the psychiatrist that he (Marco) has been experiencing moods swings for the past 3 years, but although they have been getting more frequent, they do not prevent him from carrying out his daily activities.
Nevertheless, Marco admits his emotional ups and downs have taken a toll on his relationships. Marco also reveals he has made a few risky decisions in the past year, such as making significant investments in high-risk stocks and trying recreational drugs.
Sometimes, Marko wakes up at 3am, full of energy, and drives through the city at high speed. Despite his wife’s concerns, Marco does not believe he has a mental health condition.
The psychiatrist determines Marco does not meet the criteria for bipolar disorder and diagnoses him with cyclothymia. The psychiatrist encourages Marco to stop using recreational drugs and prescribes a low dose of antidepressants and mood stabilizer.
Marco decides to come to group therapy once per week. After learning more about his condition and getting advice from people in his support group, Marco begins to see his relationships improve.
How to Deal/Coping With Cyclothymic Disorder
Individuals with cyclothymia may be tempted to stop treatment. Here are a few recommendations to cope with the condition:
Learn about cyclothymia
Speak with a therapist about cyclothymia and do research using authoritative sources. Share information with your family and friends so they can provide effective support.
Maintain a regular daily routine
Following a routine can help regulate your mood. Try to eat, sleep, and exercise at the same time each day.
Attend a support group
Ask your therapist about support groups in your area. Listening to people with similar issues will give you new ideas on how to cope with your personal concerns.
Focus on treatment
Mood swings make it difficult to stick to treatment. Stay motivated and active throughout the therapeutic process.
Take medications as prescribed
It may be tempting to skip a dosage if you feel better, but this may cause symptoms to come back.
Use healthy relaxation techniques
Breathing exercises, tai chi, yoga, or other approaches can help reduce stress.
Find positive emotional outlets
Channel pent-up emotions into positive outlets such as exercise, hobbies, or other healthy activities.
Look Out for these Complications/ Risk Factors
Trauma victims may be at increased risk of developing cyclothymia. People with a family history of bipolar disorder or depression are also more likely to develop the condition.
If you have been diagnosed with cyclothymic disorder, several factors may impact your emotions, disrupt your sleeping patterns, or interfere with your cyclothymia medication. They include:
- Alcohol
- Caffeine
- Recreational drugs
- Other medications
Cyclothymic Disorder Treatment
Cyclothymia requires lifelong treatment. This usually involves a combination of psychotherapy and medication. If left untreated, cyclothymia may increase a person’s likelihood of developing bipolar disorder by 15-50%.
Psychotherapy may be offered in individual, family, and group settings. Therapeutic modalities that have proven to be effective in the treatment of cyclothymia include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and interpersonal and social rhythm therapy (IPSRT).
Possible Medications for Cyclothymic Disorder
Although no medication is specifically approved by the Food and Drug Administration (FDA) to treat cyclothymic disorder, mood stabilizers, tranquilizers, antidepressants, anti-seizure medications, and anti-anxiety medications are often prescribed to provide symptomatic relief. Antidepressants may be combined with mood stabilizers to reduce the risk of manic episodes.
Home Remedies to Help Cyclothymic Disorder
Reports indicate omega-3 fatty acids may also help to reduce symptoms. Excellent sources of omega-3 fatty acids include:
- Roasted soybeans
- Walnuts
- Sardines
- Mackerel
- Salmon
- Canola oil
- Chia seeds
- Flax seeds
Living With Cyclothymic Disorder
It is important to stick to your prescribed treatment plan even if you feel better. Maintaining a regular schedule of therapy and medication decreases the likelihood of relapse. Eat healthy foods and get regular sleep and exercise. While there is no definite way to prevent cyclothymia, early and continuous treatment can help prevent minor symptoms from becoming full-blown episodes of major depression, mania, or hypomania.
Insurance Coverage for Cyclothymic Disorder
According to the DSM-5, cyclothymia is a diagnosable mental health condition. Your insurance plan may cover mental health issues. Contact your insurance provider to verify your coverage and obtain any needed authorization prior to visiting your doctor or therapist.
How to Find a Therapist
If you are experiencing symptoms of cyclothymia, it is important to seek medical care immediately. The condition is not likely to get better and symptoms may become much worse if left untreated. If you are hesitant to seek treatment on your own, speak with a trusted friend or family member who can help you access the professional care you need. Your doctor will refer you to a qualified mental health professional.
What Should I Be Looking For in an LMHP?
Your mental health care provider should be trained to treat the specific condition you have. Ask about his/her experience with treating cyclothymia. Other essential qualities a therapist must have include:
- Empathy
- Positivity
- Good communication skills
- Good listening skills
- Good problem-solving skills
- The ability to make you feel comfortable
- A willingness to work with you
If you do not think your therapist is a good fit for you, it may be best to ask for a referral.
Questions to Ask a Potential Therapist
Here are a few helpful questions you can ask your care provider:
- Why am I experiencing these symptoms?
- Could these symptoms be caused by anything else?
- What criteria do you use to determine my diagnosis?
- What treatments do you recommend?
- Will these treatments alleviate my symptoms?
- Will I need to receive treatment for the rest of my life?
- Are there any lifestyle changes I can make to improve my condition?
- Will I need follow up visits?
- Am I at increased risk of developing other mental health issues?
- Do you have any printed information I can read?
- What websites do you recommend?
Cyclothymic Disorder Resources and Support Helpline
People with cyclothymia may experience suicidal thoughts. If you are considering suicide right now, please call:
- 911 or your local emergency services number
- The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a mental health professional
- Your local crisis center or suicide helpline
There are a variety of online resources that may be helpful to people with cyclothymia. A few of these are listed below.
Clinical Trials/Studies:
| ● Cyclothymic Disorder – ClinicalTrials.gov |
Organizations:
| ● American Academy of Child and Adolescent Psychiatry (AACAP)● American Academy of Family Physicians (AAFP)
● Depression and Bipolar Support Alliance (DBSA) ● National Institute of Mental Health (NIMH) ● National Mental Health Association (NMHA) |
If you have cyclothymia, remember that help is available. If you seek professional care and stick to your prescribed treatment plan you will be able to manage your symptoms, build strong relationships and enjoy a long, happy, and productive life.
References:
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Mayo Clinic Staff. (2018, May 10). Cyclothymia (cyclothymic disorder). Retrieved from https://www.mayoclinic.org/symptoms-causes/syc-20371275
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Purse, M. (2017, December 24). Criteria for cyclothymic disorder: Diagnosing cyclothymia in the DSM-5. Retrieved from https://www.verywellmind.com/cyclothymia-cyclothymic-disorder-37981
Purse, M. (2017, October 6). Hypomania as a symptom of bipolar disorder. Retrieved from https://www.verywellmind.com/what-is-hypomania-how-is-it-diagnosed-380313
Support groups for cyclothymic disorder. (2009, July 23). Retrieved from https://www.networktherapy.com/resources/support_groups/topic.asp?id=269
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