Cyclothymia

Overview

What is cyclothymia?

Cyclothymia, or cyclothymic disorder, is often considered a milder and chronic form of bipolar disorder (previously known as manic-depressive disorder). People with cyclothymia experience cyclic “high” and “lows” as portrayed by large swings in mood and energy levels that negatively affect their ability to function. These changes in mood can occur quickly and at any time. A person with cyclothymia generally experiences only short periods of normal mood.

How common is cyclothymia?

Cyclothymia has been reported to occur at rates ranging from 0.4-percent to 1-percent in the general population. Because many of the symptoms of cyclothymia overlap with bipolar disorder and borderline personality disorder, the lack of clear-cut cyclothymic episodes and co-appearance of other conditions such as anxiety, irritability, or depression, many researchers think cyclothymia is considerably underdiagnosed and misdiagnosed.

Who is affected by cyclothymia?

Cyclothymia often appears in adolescence or early adulthood. Women and men are equally affected; however, it is thought that more women may seek treatment for the symptoms than men.

Symptoms and Causes

What are the causes of cyclothymia?

There is no known cause of cyclothymia. There is a possible genetic link since cyclothymia, depression, and bipolar disorder all have a tendency to run in families.

What are the symptoms of cyclothymia?

Symptoms of cyclothymia include mood swings that alternate between mild to moderate “highs” and “lows.” A “high” is defined as a distinct period of time in which a person experiences abnormal and persistently elevated or irritable mood along with an abnormal increase in activity or energy. Additional symptoms include:

  • Having a high level of self-esteem
  • Being very talkative
  • Having racing thoughts
  • Getting easily distracted
  • Having an increased focus on goals – work, school, social and sexual goals.
  • Having a feeling of being rested after as few as 3 hours of sleep
  • Having increased agitation
  • Getting overly involved in risky activities or activities that lack good judgment, such as spending sprees, sexual encounters, or unwise business decisions

A “low” is defined as a distinct period of time in which a person experiences depressed or hopeless mood and/or a decreased interest in previously enjoyed activities. Other symptoms that may be experienced during a “low” include:

  • Feelings of social isolation, low self-worth and guilt
  • Loss of appetite with weight loss
  • Difficulty falling asleep (insomnia) or trouble staying awake (hypersomnia) nearly every day
  • Fatigue or significant loss of energy
  • Decreased ability to concentrate
  • Recurrent thoughts of self injury and suicide

Diagnosis and Tests

How is cyclothymia diagnosed?

Diagnosis begins with a general medical history and physical exam, blood work to screen for substance abuse and to rule out other illnesses with similar symptoms, and mental status and psychiatric exam.

An adult is diagnosed with cyclothymia when:

  • symptoms (alternating “highs” and “lows”) have been present for at least 50 percent of the time for at least 2 years, and
  • there has not been more than a 2-month period of being symptom-free, and
  • symptoms are not due to substance abuse or a medical condition

In addition, symptoms must cause significant distress or impairment in daily functioning, but cannot be severe enough to meet criteria for either major depressive disorder or bipolar disorder.

For children and adolescents, symptoms must be present for 1 year.

Management and Treatment

How is cyclothymia treated?

By definition, symptoms of cyclothymia are not as severe as other mood disorders. As a result, individuals with cyclothymia often do not see a need for, and therefore, do not seek treatment. The goal of treatment, when it is sought, is first to stabilize mood. There are no medications that are specifically approved for the treatment of cyclothymia; however, sometimes psychiatrists may prescribe a mood stabilizer to help reduce the swings in mood.

In addition, psychotherapy may help reduce distress by teaching one to recognize, monitor and manage the symptoms of cyclothymia; cope with stressful situations; change the way one thinks and reacts and problem solves; and improve communication and interpersonal interactions.

What are the complications of cyclothymia?

Cyclothymia disrupts a person’s ability to build and maintain positive relationships. Irritability and emotional reactions have a negative effect in being able to develop successful relationships with family, friends, coworkers, and romantic partners. However, unlike the wide swings seen in bipolar disorder, patients with cyclothymia may have fewer hospitalizations, fewer days away from work, and may be able to function more consistently.

Outlook / Prognosis

What is the prognosis/outlook for patients who have cyclothymia?

Diagnosis, treatment, and management of cyclothymia is challenging. First, people with cyclothymia may not seek treatment because they may not think they have a problem. Second, many patients can be misdiagnosed as having other mood disorders or the diagnosis becomes complicated because of the presence of other psychiatric conditions. Despite these challenges, for those who do seek help, early diagnosis and treatment can result in significant improvement in long-term outlook.

Last reviewed by a Cleveland Clinic medical professional on 06/18/2018.

References

  • Perugi G, Hantouche E, Vannucchi G, Pinto O. Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. (https://www.sciencedirect.com/science/article/pii/S0165032715002967?via%3Dihub) J Affect Disord 2015;sept 1 (183):119-133. Accessed 07/02/2018.
  • Van Meter AR, Youngstrom EA, Findling RL. Cyclothymic disorder: A critical review. (https://www.sciencedirect.com/science/article/pii/S0272735812000232?via%3Dihub) Clin Psychol Rev 2012;32(4):229-243. Accessed 07/02/2018.
  • National Health Service. Cyclothymia. (https://www.nhs.uk/conditions/cyclothymia/) Accessed 07/02/2018.
  • American Psychiatric Association. What Are Bipolar Disorders? (https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders) Accessed 07/02/2018.
  • National Institute of Mental Health. Bipolar Disorder. (https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml) Accessed 07/02/2018.
  • National Alliance on Mental Illness. Bipolar Disorder. (https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder) Accessed 07/02/2018.

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