Cyclothymia is one of three main types of bipolar and is often thought the be the mildest form of the condition. Rather than experiencing alternating episodes of major depression and mania as is common in bipolar, people experiencing cyclothymia may alternate between feelings of mild or moderate depression and feelings of happiness or mild euphoria. When mood shifts such as these are experienced, therapy can help determine the cause and provide treatment.
Cyclothymia and Bipolar
Often appearing in adolescence, cyclothymia is characterized by mood disturbances that generally follow a pattern of fluctuation between symptoms of depression and hypomania, a mild form of mania. These mood shifts also characterize bipolar, but with bipolar, mood swings tend to occur in greater number and with more severity. Cyclothymia appears to occur in about 1% of the population; bipolar occurs at a slightly higher rate (in about 2.6% of Americans).
In general, those with cyclothymia may not be as likely to seek treatment as those with bipolar, possibly because the mood swings may not be severe and can potentially be attributed to normal mood shifts or other causes. Although cyclothymia appears to affect men and women equally, women seem to be more likely to seek treatment for symptoms of cyclothymia than men.
Both cyclothymia and bipolar occur with greater frequency when there is a family history of bipolar.
Symptoms of Cyclothymia
According to the Diagnostic and Statistical Manual (DSM), adults must meet the criteria for cyclothymia for at least two years in order to be diagnosed with the condition, with relief from symptoms occurring for no more than two months. For children to be diagnosed, symptoms must have been present for at least a year. Symptoms include cycling between feelings of depression and hypomania, without ever meeting the diagnostic criteria for major depression, mania, or hypomania. Symptoms must not be related to or caused by major life events, such as the death of a loved one or the birth of a child. For a diagnosis of cyclothymia, the symptoms must be severe enough to interfere with daily life, but not severe enough to warrant a diagnosis of bipolar.
Common symptoms and behaviors characteristic of cyclothymia include:
- Periods of worthlessness, isolation, and loneliness that are not severe enough to completely limit functioning.
- Sudden onset of a happier, elevated mood that may be euphoric and enjoyable.
- Risk-taking and increased activity during periods of euphoria.
- Chronic mood instability.
- Minor episodes of depression.
People with cyclothymia may also experience substance abuse issues or problems sleeping, and children who are diagnosed with cyclothymia are more likely to experience ADHD than their peers.
Types of Treatment
Cyclothymia is a treatable condition. There is a 15–50% risk that bipolar will develop where cyclothymia is present, so the reduction of this risk will often be an important part of treatment. Because alcohol and drug use may increase or worsen the severity of symptoms, any substance use issues might also be discussed and treated. In therapy, triggers for hypomanic and depressive episodes can be explored, and methods to cope with stressful or upsetting situations can be developed.
Cognitive behavioral therapy may be helpful with the reframing of negative thoughts that may occur during a depressive episode, and family therapy may be helpful when members are affected by a loved one's diagnosis. In therapy, family members can learn more about the condition and how they can help reduce stressors that might occur within the family. Group therapy might also be beneficial to those with cyclothymia, as the condition and symptoms be discussed with others who are experiencing the same. Interpersonal social rhythm therapy, which can help improve management of a daily routine, might also be beneficial in addressing aspects of cyclothymia that might have an effect on relationships and daily tasks.
In addition to therapy, medication is also often prescribed to treat cyclothymia. Mood stabilizers, antidepressants, and anti-anxiety medications may all be helpful for relieving symptoms of cyclothymia. However, antidepressants are typically combined with mood stabilizers to reduce the risk of manic episodes, which may occur when an antidepressant is used alone in the treatment of this condition. Psychiatrists also sometimes prescribe antipsychotic medication to people with cyclothymia, but this treatment course is more common among people with bipolar. Anti-seizure medication has also been shown to be helpful.
While not a medication, omega-3 fatty acids have been shown to be potentially helpful in the reduction of cyclothymia symptoms.
Case Example
- Mood shifts and risky behavior in college student: Nita, 19, reluctantly makes an appointment at her university's mental health clinic after her roommate expresses concern about Nita's "wild behavior." Nita tells the counselor that since high school, her moods have changed frequently, but not severely, though she often experiences feelings of lowness and hopelessness. Though these sometimes rapidly went away, leaving her feeling happy and excited about life, she and others around her imagined that the shifts were due to the various stresses of high school life. Nita admits that she imagined they would clear up when she began college, but they have not. Her mood still fluctuates often between "up and down," she states. She is able to pursue her normal activities and stick to her daily routine, but she reports that she finds it difficult to do so at times. Nita relays to the counselor that she believes the mood shifts have become more frequent since college began, and when asked, she admits that she also began drinking after beginning college, as well, and that she has engaged in some risky acts, such as driving and having unsafe sex while intoxicated. Through questioning, the counselor determines that Nita has not experienced a full manic or depressive episode and refers her to a psychiatrist, who diagnoses Nita with cyclothymia and prescribes her a low dose of antidepressant and mood stabilizer. Nita resolves to stop drinking after being told that it may worsen her symptoms, and she begins to attend biweekly therapy sessions. She also joins a school support group for students with mental health conditions and is able to form new friendships as her mood stabilizes and improves.
References:
- Bipolar Disorder. (n.d.). Retrieved from http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.
- Cyclothymia. (n.d.). Retrieved from http://www.depressionperception.com/depression/cyclothymia.html.
- Cyclothymia (cyclothymic disorder). (2012, June 13). Retrieved from http://www.mayoclinic.org/diseases-conditions/cyclothymia/basics/treatment/con-20028763.
- Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
- Kerr, M. (2012, March 29). Clyclothymia. Retrieved from http://www.healthline.com/health/depression/cyclothymia#1.
