Cyclothymia (Cyclothymic Disorder): Symptoms, Causes, Treatment, Risks

Cyclothymia (Cyclothymic Disorder)

Cyclothymia – also known as cyclothymic disorder – is a somewhat milder form of mood disorder. Cyclothymia is characterized by emotional ups and downs that are not comparable to those experienced by people suffering from bipolar disorder type I or II. The mood swings are not so extreme and may at times be considered within a person’s normal range of emotions as they cover a wide spectrum: they can be experienced as a mild depression, or as a mild mania.

It is therefore understandable for cyclothymia to remain undiagnosed in many cases, and for people suffering from the disorder to also remain unaware that they suffer a disease that is treatable and that they could enjoy a much better healthy life with an appropriate treatment.

People diagnosed with cyclothymia experience their periods when their mood significantly swings up and down. Between these cyclothymic highs and lows, most people suffering from cyclothymic disorder usually feel stable and fine.

Who is at risk for cyclothymic disorder / cyclothymia ?

Lifetime prevalence for cyclothymic disorder – or cyclothymia – in the world population is estimated to be less than 1%. Cyclothymic disorder appears to affect slightly more women than men. Women who suffer from cyclothymia also seek more often and earlier professional help than men when they experience the depressive phase.

From all patients suffering from cyclothymia, about one in three of them do have family histories of bipolar disorder type I, that is, a bipolar disorder that involves full-blown manic episodes alternating with short periods of relative emotional stability. The risk for getting cyclothymia is correspondingly much higher in families with bipolar disorder type I than in families with other types of mental disorders. Approximately one-third of the patients who suffer from cyclothymic disorder are also reported to develop later a major mood disorder.

Cyclothymia – or cyclothymic disorder – appears very often early in life, either in adolescence or young adulthood. Cyclothymic disorder usually has a malicious onset and a chronic course; cyclothymia is therefore frequently difficult to diagnose. When a person suffers from cyclothymia, he or she is at up to 50% higher risk to subsequently develop bipolar disorder type I or type II.

Complications of cyclothymic disorder / cyclothymia

When cyclothymic disorder / cyclothymia remains undiagnosed and untreated, the disorder can develop and eventually result in significant emotional problems that can disrupt every area of a person’s life. Cyclothymic disorder / cyclothymia can also develop further into the illness bipolar disorder type I or II.

Bipolar disorder type I – also called manic depression and manic depressive disorder – is a so-called “brain illness” that is characterized by manic or mixed episodes. The manic phase of bipolar disorder is also characterized by an episode of feeling "high," or an overly happy or outgoing mood associated with high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Bipolar disorder type II is a so-called “brain illness” that is characterized by a combination of depressive episodes and hypomanic episodes. Bipolar disorder type II is basically very similar to bipolar disorder type I. The manic phase of bipolar disorder type II is also characterized by an episode of feeling "high" alternating with low moods. Bipolar disorder type II does not cause full-blown manic or mixed episodes, but hypomania which is a milder form of mania. In bipolar disorder II, the periods of depression are usually experienced for a longer time than those of hypomania.

The people suffering from this disorder may be more irritable and show an elevated mood but they can – in most cases – assume their usual daily work or routine in between their episodes of hypomania and their phases of depression.

Symptoms of cyclothymic disorder / cyclothymia

Cyclothymia symptoms alternate between mild depression and hypomania. In most people suffering from cyclothymia, the pattern of these emotional highs and lows is both irregular and unpredictable. The “highs” of cyclothymia consist of hypomanic symptoms that resemble those of mania, but that are less severe. The lows consist of mild depressive symptoms.

Cyclothymia symptoms are very similar to those caused by bipolar disorder type I or II, but they are less severe. When a person experiences cyclothymia, he or she can shoulder some tasks in their daily life, at least to a certain degree. However, the unpredictable mood shifts of your cyclothymic disorder may affect significantly your life as you can hardly make plans.

An episode of hypomania or depression in cyclothymia can last for a few days or a few weeks. In between his or her “highs” and “lows”, a person suffering from cyclothymia may live with “normal” moods for a period lasting over a month or can experience unremittingly swings from hypomanic to depressed episodes, with no normal period in between.

Hypomanic phase of cyclothymia / cyclothymic disorder

The signs and symptoms of the hypomanic phase of the illness cyclothymia / cyclothymic disorder usually include –

Mood Changes in cyclothymia / cyclothymic disorder - hypomanic phase:

• An exaggerated feeling "high," or an overly happy or outgoing mood
• Extremely irritable mood, agitation, feeling "jumpy" or "wired.

Behavioral Changes in cyclothymia / cyclothymic disorder - hypomanic phase:

• Talking very fast, jumping from one idea to another, having racing thoughts
• Being easily distracted
• Increasing goal-directed activities, such as taking on new projects
• Being restless
• Sleeping little
• Having an unrealistic belief in one's abilities
• Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments

Depressive phase of cyclothymia / cyclothymic disorder

The signs and symptoms of the depressive phase of the illness cyclothymia / cyclothymic disorder usually include –

Mood Changes in cyclothymia / cyclothymic disorder - depressive phase:

• A long period of feeling worried or empty
• Loss of interest in activities once enjoyed, including sex.

Behavioral Changes in cyclothymia / cyclothymic disorder - depressive phase:

• Feeling tired or "slowed down"
• Having problems concentrating, remembering, and making decisions
• Being restless or irritable
• Changing eating, sleeping, or other habits
• Thinking of death or suicide, or attempting suicide

If compared with the severity of the episodes of hypomania and depression of bipolar disorder type I and II, the symptoms of cyclothymia can be described as a mild disorder although it can completely disrupt a person’s life. The symptoms triggered during the depressive phase in cyclothymia never reach the diagnostic criteria settled for major depression or any other type of bipolar disorder.

Many people who experience cyclothymic disorder suffer from their unpredictable moods and irritability and find it extremely difficult to succeed in their work and in their relationships since they never know what mood to expect for the next hours or day.

On the other hand you also find another group of people who are not impaired during the highs and function better than average: they can work longer hours without getting tired, are more productive and more creative. In these people displaying excessive forms of behavior, both relationships and friendships suffer and divorce is very common.

What Causes cyclothymic disorder / cyclothymia ?

What specifically causes cyclothymic disorder / cyclothymia is still unknown. However, researchers believe that a combination of factors that are also found in major depression and bipolar disorder, triggers cyclothymia. The causative factors are a combination of:

• Heredity - A person diagnosed with cyclothymic disorder / cyclothymia usually has a family history of bipolar disorder, major depression, suicide, or alcohol or drug dependence.

• Brain chemistry - An imbalance in the natural brain chemistry may also play a significant role in the triggering of cyclothymic disorder / cyclothymia.

• Stressful events - The loss of a job or of a loved one, a divorce or separation, a natural disaster, a change of identity, extreme negative thoughts, etc. can be factors that may contribute to the triggering of cyclothymic disorder / cyclothymia.

• Environment - Environmental influence like alcohol and drugs, stress in general and sometimes consistent lack of sleep is also likely to trigger cyclothymic disorder / cyclothymia.

Up to every second patient suffering from cyclothymic disorder / cyclothymia is likely to be diagnosed one day with the illness “bipolar disorder” after experiencing a major depression or a full-blown manic episode.

Your appointment with a professional for cyclothymic disorder / cyclothymia

Taking the decision to seek help for your cyclothymic disorder / cyclothymia and making a first appointment with your primary care doctor is most probably the most important step you can make in this connection to improve your condition. Your doctor will most probably refer you to a specialist, a mental health provider, who will diagnose you and work out an appropriate treatment plan for your specific cyclothymic disorder / cyclothymia.

It is always a good idea to get prepared for your appointment and to bring along with you your “My Cyclothymia Diary” in which you have written down – as detailed as possible – when and under which circumstances your cyclothymic disorder / cyclothymia have occurred and for how long, how you have tried to deal with them, and what results you have obtained.

It is also recommended to make a check list of all of your key personal information, possible stresses, and important recent changes in your life and to describe shortly how badly and when your “symptoms of cyclothymic disorder / cyclothymia” have affected you.

To complete the picture, you can work out a list of all your medications, inclusive dosages and directions and ask a trusted family member or friend to accompany you to your appointment, and help you remember all information you will receive to cope and treat your symptoms of cyclothymic disorder / cyclothymia.

Important questions during your first appointment with doctor

In order to make sure that your most important questions associated with your cyclothymic disorder / cyclothymia are discussed and cleared during your first appointment, you are expected to work out a corresponding list that might include such and other points:

• What factors may trigger my symptoms?
• Can you exclude other causes?
• How are you going to determine my diagnosis?
• Do I need to be transferred to a health specialist?

If you are referred to a health specialist, you can ask following questions:

• What do I suffer from? What is my diagnosis?
• What treatment would you suggest?
• You have seen in my personal information that I also suffer from…  Can your suggested treatment negatively interfere with the medications I am presently taking?
• What improvement can I expect with the suggested treatment and when am I going to notice an improvement?
• What about the possible side effects with your suggested depression treatment?
• Will I have to take medication for the rest of my life or can my symptoms be cured?
• Am I at risk – with treatment – to develop another more serious mental disorder?
• Do you have any further printed information related to my disorder

Your doctor or mental health provider may also ask you following or similar questions:

• What incited you to seek treatment?
• How would you describe the symptoms you are experiencing?
• How would the people around you describe your symptoms?
• When did you first take notice of your symptoms?
• When did the people around first notice your symptoms?
• Would you say that your symptoms have worsen or become better in the meantime?
• Have you experienced severe episodes of highs and lows? In the affirmative, how long have these periods lasted?
• Have you also had periods with relatively stable moods in between?
• How would you describe your emotional state during the highs and the lows? How would the people around you describe your state?
• How has your behavior changed between your episodes of highs and lows? How would the people around you answer the same question?
• Have your need for sleep, food or sex changed between your episodes of highs and lows?
• Have your episodes of highs and lows affected your life, relationships, school or work?
• Do you have close relatives who have displayed similar symptoms?
• Have you already been diagnosed and treated for other symptoms or mental illness? In the affirmative, what type of therapy was most beneficial for you?
• Have you ever developed thought about harming yourself or somebody else?
• Do you consume alcohol or illegal drugs? If you do, how often?

Test and Diagnosis for cyclothymic disorder / cyclothymia

Seeking treatment for your symptoms of “cyclothymic disorder / cyclothymia”, you have finally made an appointment with a recommended health care provider. To begin with, he or she will make you pass a thorough physical exam to find out if your symptoms are caused by any of the following conditions: cyclothymic disorder / cyclothymia, bipolar disorder type I or II, depression or another condition that might be responsible for the felt symptoms.

He or she will also let you answer a lot of question to find out about your present psychological state and your cyclothymic disorder / cyclothymia. As typical laboratory tests to diagnose cyclothymic disorder / cyclothymia do not exist yet, lab tests will concentrate on blood and thyroid tests. A urinalysis or a test for alcohol and drug consumption may also be done.

You will be asked by your doctor or mental health provider to describe your thoughts, feelings and behavior patterns as accurately as possible, and to fill in some psychological self-assessments. Your doctor or mental health provider will most probably also ask you to fill in a few psychological questionnaires to allow determine a correct diagnosis. He may also ask for your permission to question people around you about the way they perceived your symptoms and episodes of depression and mania.

What are the Treatments for cyclothymic disorder / cyclothymia ?

Psychotherapy and medications are then usual options to treat cyclothymic disorder / cyclothymia. Because of its relatively mild symptoms, cyclothymic disorder / cyclothymia might never be diagnosed in a person affected by the disorder. Cyclothymic disorder / cyclothymia does not necessarily need to be treated. In some persons, a degree of hypomania in cyclothymic disorder / cyclothymia may be responsible for a person's success in life.

However, for those patients with a family history of bipolar disorder or who are at risk for a depressive episode, prompt and effective treatment should be sought to avoid drastic consequences. Cyclothymic disorder / cyclothymia is a disease that requires lifelong treatment, even when you feel fine. The treatment is usually accompanied by a specialized mental health provider. To successfully treat your cyclothymic disorder / cyclothymia, your doctor or psychotherapist will focus on following issues:

• Decreasing your potential risk of developing bipolar disorder type I or II - Cyclothymic disorder / cyclothymia is always at high risk of developing into a significantly more severe bipolar disorder.

• Reducing the effects of the symptoms of cyclothymic disorder / cyclothymia - The reduction of both the severity and the frequency of the symptoms in cyclothymic disorder / cyclothymia will put you in a position to live a much more balanced and enjoyable life and allow positive results in your work and in your relationships.

• Preventing a relapse of your cyclothymic disorder / cyclothymia - The best option to avoid or prevent a relapse of your cyclothymic disorder / cyclothymia consist in assuring a kind of “maintenance” treatment, that is, by consistently continuing to treat your cyclothymic disorder / cyclothymia, even during the remission periods.

• Treating alcohol and/or drugs abuse - For many cyclothymic disorder patients it is fairly common to abuse alcohol and/or other drugs as self-medication. Approximately between 5 and 10 per cent of all patients affected with cyclothymic disorder / cyclothymia are said to also suffer from substance dependence.

The usual treatment options for cyclothymic disorder / cyclothymia are appropriate medications and psychotherapy.

Medications for cyclothymic disorder / cyclothymia 

Appropriate medications may help keep the symptoms of cyclothymic disorder / cyclothymia under control and also prevent the occurrence of hypomania and depression episodes. Usually administrated medications to treat cyclothymic disorder / cyclothymia include:

Mood stabilizers – an option to treat cyclothymic disorder / cyclothymia

Mood stabilizers are widely and successfully used to regulate and stabilize the patient’s mood in order to avoid the alternating swings between hypomania and depression. Very often, doctors and psychotherapists recommend people suffering from cyclothymic disorder / cyclothymia to take their prescribed mood stabilizers for the rest of their life with the objective of treating their hypomanic episodes and to prevent a relapse.

Antipsychotics – an option to treat cyclothymic disorder / cyclothymia

Antipsychotic medications are also an option for people who suffer from cyclothymic disorder / cyclothymia but who do not react positively on anti-seizure medications.

Anti-anxiety medications – an option to treat cyclothymic disorder / cyclothymia

Anti-anxiety medications may be indicated to help people with cyclothymic disorder / cyclothymia improve their sleep and so contribute to the stabilization of the mood.

Antidepressants – an option to treat cyclothymic disorder / cyclothymia

Antidepressants must be taken very cautiously. If not taken in combination with a mood stabilizer or an antipsychotic medication, antidepressants may trigger severe and dangerous manic episodes in people suffering from cyclothymic disorder / cyclothymia. It is therefore recommended to first discuss the issue with your doctor or psychotherapist before you start taking antidepressants.

----------------------------------

Taking your personal situation into consideration, your doctor will choose a specific antidepressant or of a combination of medications. Please keep in mind that it can last a few weeks before a medication starts showing improvement in your cyclothymic disorder / cyclothymia symptoms. Should you experience that a prescribed medication does not bring the expected results or generates disturbing side effects, do not panic, continue to take the prescribed antidepressants and inform your doctor correspondingly and with full details.

You should be aware that certain depressants may even worsen your cyclothymic disorder / cyclothymia when the therapy is stopped suddenly. In other words, you cannot stop abruptly taking the chosen antidepressant, and create so-called withdrawal symptoms until a more suitable and appropriate medication – with more tolerable side effects – is found to combat your cyclothymic disorder / cyclothymia.

It is always a good idea to discuss thoroughly the pros and cons of possible side effects with a professional and to make up your own decision.  People suffering from cyclothymic disorder / cyclothymia may have to continue taking antidepressants for the rest of their life in order to be able to keep their mood under control.

Psychotherapy for cyclothymic disorder / cyclothymia

Psychotherapy – sometimes called “therapy” for short or talk therapy, or counseling – is best indicated to treat effectively people who suffer from cyclothymic disorder / cyclothymia. Through psychotherapy people learn to better understand what cyclothymic disorder / cyclothymia is it is professionally treated.

Types of therapy that can be used to treat successfully cyclothymic disorder / cyclothymia include:

Cognitive behavioral therapy

Cognitive behavioral therapy is said to be the most commonly applied one for cyclothymic disorder / cyclothymia; its objective is to make people learn – using their own experience – to recognize and detect unhealthy, negative views and behaviors and systematically replace them with healthy, positive ones. Through cognitive behavioral therapy you are given the possibility to find out what causes the hypomanic or depressive episodes in your cyclothymic disorder / cyclothymia. Most important, you also learn practically how to deal with your stress and manage displeasing or disconcerting situations.

Family therapy

Family therapy does not only help you – but your family members too – to learn communicating and resolving conflicts with instead of against each other. Such family therapy is usually helpful to identify what triggers unhealthy behavior patterns. During the therapy sessions, your family members will learn a lot about your condition dictated by cyclothymic disorder / cyclothymia and will slowly realize why you think and react differently.

Group therapy

Group therapy gives you the opportunity to communicate with people who – like you – suffer from cyclothymic disorder / cyclothymia, and to learn from them. Participating in a group therapy may be beneficial to you to build better relationship skills.

How to Cope with cyclothymic disorder / cyclothymia

Coping with cyclothymic disorder / cyclothymia can prove difficult for many people. The medications prescribed by your doctor or psychiatrist may have severe side effects, and you may feel angry about having to treat your cyclothymic disorder cyclothymia for the rest of your life. Moreover, you may consider stopping the treatment of your cyclothymic disorder / cyclothymia when you start feeling better, that is, during the hypomanic episodes. Here are some tips to help you get along with your cyclothymic disorder / cyclothymia:

Learning about the disorder – a way to better cope with cyclothymic disorder / cyclothymia

Getting a maximum of information about cyclothymic disorder / cyclothymia and its possible complications can be a good way to motivate you to stick to the treatment plan agreed upon with your doctor or psychologist.

Joining a support group – a way to better cope with cyclothymic disorder / cyclothymia

Joining a local support groups for people who also have to live with cyclothymic disorder / cyclothymia can help you reach out to other people who also have to face similar or worse challenges than you.

Staying focused on your objective – a way to better cope with cyclothymic disorder / cyclothymia

Treating successfully cyclothymic disorder / cyclothymia is a lifelong issue. To get along with your disorder and live an enjoyable life, you absolutely have to stay motivated all your life by keeping your objective in mind.

Finding healthy outlets – a way to better cope with cyclothymic disorder / cyclothymia

Finding healthy and pleasant ways to channel your energy can only be beneficial for you, the people around you and your cyclothymic disorder / cyclothymia. Care for your hobbies, do exercises and recreational activities.

Learning relaxation and stress management – a way to better cope with cyclothymic disorder / cyclothymia

Try any kind of stress-reduction techniques like progressive muscle relaxation, meditation, yoga or tai chi, etc. It will help you better manage your stress.

Recommendations to better manage your cyclothymic disorder / cyclothymia

As soon as you are diagnosed with cyclothymic disorder / cyclothymia, you should do your best to learn as much as possible about your cyclothymia. The more you know about cyclothymic disorder / cyclothymia, the better you can deal with it. In addition to the treatment plan agreed upon with your doctor or psychiatrist, you may follow these recommendations to better manage your cyclothymic disorder:

Taking your medications as prescribed will help managing your cyclothymic disorder / cyclothymia

Taking your medications regularly and in the way indicated by your doctor or psychiatrist is very important, even when you experience difficulties with the side effects. In such cases, resist the temptation to stop taking your medicines, continue taking the prescribed dose and arrange a meeting with your doctor or psychiatrist.  If you stop abruptly taking your medicines or reducing the dose without informing your doctor, your condition may worsen significantly and the signs and symptoms of cyclothymic disorder / cyclothymia are likely to reappear within soon.

Paying attention to warning signs will help managing your cyclothymic disorder / cyclothymia

Paying attention to the warning signs associated with your cyclothymic disorder / cyclothymia will help you recognize and better identify possible patterns to your episodes of cyclothymic disorder / cyclothymia and what situations are likely to trigger them. If you have the impression that you are facing a symptomatic episode, get immediately in touch with your doctor or psychologist and take corresponding preventive actions, such as reducing or simplifying your schedule. Involve people around you in watching for warning signs.

Avoiding alcohol and illegal drugs will help managing your cyclothymic disorder / cyclothymia

Avoiding alcohol and illegal drugs is a very important step in your endeavors to managing your cyclothymic disorder / cyclothymia. Alcohol and illegal drugs are known for their exacerbating any kind of mood disorders. If you find it tremendously difficult to stop consuming alcohol and illegal drugs on your own – what is perfectly understandable – we would suggest you to seek for professional help.

Keeping in touch with your doctor or psychiatrist will help managing your cyclothymic disorder / cyclothymia

If you happen to have to take some medicine for another illness – prescribed by another doctor – keep immediately in touch with the doctor or psychiatrist who has worked out the treatment plan for your cyclothymic disorder / cyclothymia. It should always be ascertained that other medications do not interfere with those belonging to the treatment of your cyclothymic disorder / cyclothymia and that they are not likely to trigger some episodes of cyclothymia.

Keeping a record will help managing your cyclothymic disorder / cyclothymia

Keeping a “My Cyclothymia Diary” up to date is always a good idea. Put down the maximum of details about your moods, your daily routines and what you believe to be important events. Your “My Cyclothymia Diary” can be very beneficial to both you and your doctor or psychiatrist to better understand the effects of the on-going treatment and recognize different thinking patterns and behaviors directly connected with symptoms of cyclothymic disorder / cyclothymia.

How to Prevent cyclothymic disorder / cyclothymia ?

We are often asked the question: “Can cyclothymic disorder / cyclothymia be prevented?”  There is of course no sure way yet to prevent cyclothymic disorder / cyclothymia to occur or to foretell what situation is likely to cause a person to develop cyclothymic disorder / cyclothymia. However being diagnosed and receiving appropriate treatment at the very beginning of the mental health disorder can be tremendously helpful to prevent cyclothymic disorder / cyclothymia from aggravating.

Moreover, everybody can take self-care steps in order to minimize the impact of cyclothymic disorder / cyclothymia and to prevent so-called “minor episodes” from worsening and developing into full-blown episodes of mania or depression.