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We’ve all experienced an occasional mood swing, but people with cyclothymia know extreme emotional fluctuations can be debilitating. Loved ones can also feel the impact since relationships might become difficult and strained. Fortunately, treatment is available. Here’s what you should know about this mood disorder and what options exist to help manage your symptoms.
What is cyclothymia?
Cyclothymia (also called cyclothymic disorder) is a chronic mental illness that causes your mood to cycle between emotional highs and lows. Despite being considered a less severe form of bipolar disorder, cyclothymia has the potential to significantly impact your functioning and quality of life. Individuals with cyclothymia can struggle with their daily routines, social and work functions, and might have trouble maintaining positive relationships as a result of their condition. Other mental health disorders, such as ADHD, anxiety, or substance abuse, often occur with cyclothymia, causing further complications (Van Meter, 2012).
Cyclothymia is typically diagnosed in young adults and occurs in 0.4–1% of the population (Bielecki, 2021). Researchers believe, however, that cyclothymia is underdiagnosed and the actual percentage of people affected is likely greater.
Healthcare providers sometimes struggle to make the correct diagnosis if you have cyclothymia, since this condition shares many similar symptoms with other related disorders. Plus, many people don’t seek treatment because they might not believe their symptoms are severe enough (Van Meter, 2012). Together, these factors mean cyclothymia might affect more people than we realize.
Bipolar disorder: types, symptoms, causes, medications
Symptoms of cyclothymia
People with cyclothymia experience frequent mood changes, shifting from emotional highs (hypomania) to lows (depressed mood). While some people can identify clear episodes of a high or low mood, many people with cyclothymia experience mixed episodes where both hypomanic and depressive symptoms occur simultaneously (Van Meter, 2012).
Hypomanic symptoms are often described as an elevated mood or an emotional high. But since people with cyclothymia often experience irritability and agitation, their hypomanic symptoms aren’t always pleasant. In fact, they can sometimes be pretty distressing (Van Meter, 2012). These symptoms are called hypomanic because they aren’t quite as extreme as the highs a person with bipolar disorder might feel, which are called manic symptoms.
Hypomanic symptoms include (Jain, 2021):
- An exaggerated feeling of self-esteem or importance
- Decreased need for sleep
- Talking quickly and much more than is normal for you
- Increase in goal-directed activities (at work or school, socially, or sexually)
- Racing thoughts
- Difficulty focusing
- Jumping from one idea to another
- Agitation and restlessness
- Increase in impulsive or risky behaviors (unwise business decisions, spending-sprees, risky sexual behaviors)
People with cyclothymia can go from feeling on top of the world to depressed and hopeless, sometimes multiple times per day (Van Meter, 2012).
Bipolar 1 vs. 2: what are the key differences?
Depressive symptoms include (Bielecki, 2021; Jain, 2021):
- Feeling sad, hopeless, or “empty”
- Inability to find pleasure in the things you once enjoyed
- Changes in body weight
- Increase or decrease in appetite
- Trouble sleeping or sleeping too much
- Trouble concentrating or focusing
- Low energy
- Feelings of guilty or worthlessness
- Lack of motivation
- Suicidal thoughts or behaviors
Causes and risk factors of cyclothymia
Like many mental health disorders, researchers don’t know for sure exactly what causes cyclothymia, but it’s likely a combination of changes in brain function, genetics, and environmental factors. Having a family member with cyclothymia increases your chances of developing this condition. Stressful or traumatic experiences can also put you at greater risk (Bielecki, 2021).
Diagnosis of cyclothymia
Cyclothymia is diagnosed based on your symptoms. Your healthcare provider will ask you a series of questions regarding your mood, prior psychiatric and medical conditions, family history, and substance use history. They may also have you complete a questionnaire about your symptoms. You’ll likely also need some blood work and scans to rule out any other conditions that could be causing your symptoms (Bielecki, 2021).
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—developed by the American Psychiatric Association—says you need the following to get a diagnosis of cyclothymia (Bielecki, 2021):
- You experience many periods of emotional highs and lows for at least two years, and your symptoms are present for at least half of the time.
- Your mood is stable or returns to baseline for less than two months at a time.
- Your symptoms cause significant distress or impact your functioning at school, work, or in social situations.
- You have never met the criteria for a manic episode or major depression.
- Your symptoms are not due to another psychiatric or medical condition and are not the result of substance abuse.
While cyclothymia includes high and low mood swings, you’ll notice that it doesn’t include full-on manic episodes or major depression. Those features would likely classify you as having a different type of bipolar disorder.
Treatment of cyclothymia
Cyclothymia is a chronic condition that requires lifelong treatment, even when you are feeling well. While there is no cure for cyclothymia, treatment can help control your symptoms and improve your functioning. Your healthcare provider will likely recommend psychotherapy (talk therapy) and medications (Bielecki, 2021).
Psychotherapy includes a combination of cognitive-behavioral therapy (CBT) and well-being therapy, and helps improve symptoms in people with cyclothymia (Fava, 2011).
CBT enables you to recognize problematic thought patterns and behaviors and replace them with healthy ones (Chand, 2021). Well-being therapy involves identifying times when you are feeling emotionally well. Using a diary, you will record these periods and then take note of thoughts or behaviors that cause your mood to shift, making you feel unwell. Working with your mental health professional, you will develop strategies that promote periods of wellness (Guidi, 2018).
Cognitive-behavioral therapy (CBT): what is it and what does it work for?
The FDA currently approves no medications to treat cyclothymia, but healthcare providers often prescribe the same drugs used to treat bipolar disorder. These include mood stabilizers like lithium, anti-seizure medications like valproate (brand name Depakote) and lamotrigine (brand name Lamictal), and antipsychotics. Antidepressants should not be used alone to treat cyclothymia as they can worsen symptoms, potentially increasing the likelihood of experiencing hypomanic symptoms (Perugi, 2015).
Prevention of cyclothymia
There is no way to prevent cyclothymia, but it’s critical to seek care as soon as you begin to feel unwell. Early treatment can prevent your symptoms from getting worse. People with cyclothymia are at increased risk of developing bipolar I or bipolar II disorder, making it even more important to receive appropriate care early (Van Meter, 2012).
Cyclothymia can be a distressing condition, not only for the person suffering from the disease but also for their loved ones. Luckily, there is help available. Talk with your healthcare provider about any concerns you have regarding your mood. Together, you can review your treatment options and get you on track to feeling your best.
- Bielecki, J. E., & Gupta, V. (2021). Cyclothymic disorder. In StatPearls. StatPearls Publishing. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32491800/
- Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2021). Cognitive behavior therapy. In StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29261869/
- Fava, G. A., Rafanelli, C., Tomba, E., Guidi, J., & Grandi, S. (2011). The sequential combination of cognitive behavioral treatment and well-being therapy in cyclothymic disorder. Psychotherapy and Psychosomatics, 80(3), 136–143. doi: 10.1159/000321575. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21372621/
- Guidi, J., Rafanelli, C., & Fava, G. A. (2018). The clinical role of well-being therapy. Nordic Journal of Psychiatry, 72(6), 447–453. doi: 10.1080/08039488.2018.1492013. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30445901/
- Jain, A., & Mitra, P. (2021). Bipolar affective disorder. In StatPearls. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32644424/
- Perugi, G., Hantouche, E., Vannucchi, G., & Pinto, O. (2015). Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. Journal of Affective Disorders, 183, 119–133. doi: 10.1016/j.jad.2015.05.004. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26005206/
- Van Meter, A. R., Youngstrom, E. A., & Findling, R. L. (2012). Cyclothymic disorder: a critical review. Clinical Psychology Review, 32(4), 229–243. doi: 10.1016/j.cpr.2012.02.001. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22459786/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.