Cyclothymia

What is cyclothymia?

Cyclothymia (cyclothymic disorder) is a milder form of bipolar disorder. It involves frequent mood swings of hypomanic and depressive episodes.

Bipolar disorder is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for days, weeks or months. They can interrupt your ability to carry out day-to-day tasks.

People with cyclothymic experience episodes of hypomania and mild depression for at least two years. These changes in mood can occur quickly and at any time. A person with cyclothymia may have brief periods of normal mood (euthymia), but these periods last fewer than eight weeks.

Who does cyclothymia (cyclothymic disorder) affect?

Cyclothymia most often appears in adolescence or early adulthood.

How common is cyclothymia (cyclothymic disorder)?

Cyclothymia affects approximately 0.4% to 1% of people in the United States.

Because many of the symptoms of cyclothymia overlap with other mental health conditions, many researchers think cyclothymia is considerably underdiagnosed and misdiagnosed.

What are the symptoms of cyclothymia (cyclothymic disorder)?

Symptoms of cyclothymia include mood swings that alternate between episodes of hypomania and mild depression.

While mood changes in bipolar I and II disorders happen over weeks, months and sometimes even years, mood changes in cyclothymia can happen spontaneously over brief periods — even within the same day.

Hypomania symptoms in cyclothymia

Hypomania is a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level and activity level. This energized level of energy, mood and behavior must be a change from your usual self and be noticeable to others. Hypomania is a less severe form of mania.

Signs and symptoms of hypomania include:

• Increased energy and less need for sleep.
• Rapid speech and racing thoughts.
• Being easily distracted.
• Having an increased focus on goals, including work, school and social goals.
• Participating in risky activities or activities that lack good judgment, such as spending sprees, reckless sexual encounters or impulsive business decisions.
• Higher-than-normal level of self-esteem.

Depressive symptoms in cyclothymia

A depressive episode involves feelings of hopelessness and a decreased interest in previously enjoyed activities. The symptoms of depressive episodes in cyclothymia are milder than those of major (clinical) depression.

Signs and symptoms of a depressive episode include:

• Feelings of social isolation, low self-worth and guilt.
• Changes in eating patterns (eating more or less than usual).
• Difficulty falling asleep (insomnia) or trouble staying awake (hypersomnia).
• Fatigue or significant loss of energy.
• Decreased ability to concentrate.

What causes cyclothymia?

Researchers don’t know what exactly causes cyclothymia. They think there may be a genetic link, as cyclothymia, depression and bipolar disorder all tend to run in families.

Traumatic events or experiences may trigger cyclothymia in some people, such as severe illness or long periods of stress.

How is cyclothymia (cyclothymic disorder) diagnosed?

It can be difficult for healthcare providers to diagnose cyclothymia, as it has many overlapping symptoms of other mental health conditions, including:

• Major depressive disorder.
• Bipolar II disorder.
• Generalized anxiety disorder.
• Neurodevelopmental disorders.
• Personality disorders.

To diagnose cyclothymia, a provider may use many tools, including:

• A physical exam.
• A thorough medical history, which will include asking about your symptoms, lifetime history, experiences and family history.
• Medical tests, such as blood tests, to rule out other conditions that could be causing your symptoms, such as hyperthyroidism or substance use.
• A mental health evaluation. Your provider may perform the evaluation, or they may refer you to a mental health specialist, such as a psychologist or psychiatrist, to get one.

Providers diagnose cyclothymia when:

• Your symptoms (alternating hypomanic and depressive episodes) have been present for at least 50% of the time for at least two years. For children and adolescents, symptoms must be present for one year.
• You haven’t experienced more than two months of being symptom-free.
• Your symptoms aren’t due to substance use or a medical condition.

In addition, the symptoms must cause significant distress or impair daily functioning. But they can’t be severe enough to meet the criteria for either major depressive disorder or bipolar disorder.

How is cyclothymia treated?

Unfortunately, most people who have cyclothymia have symptoms that are mild enough that they don’t seek medical treatment and/or they don’t think they have a medical condition.

Treatment for cyclothymia usually involves psychotherapy (talk therapy) and medication.

Psychotherapy is a term for a variety of treatment techniques that aim to help a person identify and change unhealthy emotions, thoughts and behaviors through conversations with a licensed mental health professional.

There are several different types of psychotherapy. Studies have shown that cognitive behavioral therapy (CBT) specifically works best to help treat cyclothymia.

Psychotherapy can help reduce distress by teaching you to:

• Recognize, monitor and manage the symptoms of cyclothymia.
• Cope with stressful situations.
• Change the way you think, react and problem-solve.
• Improve communication and interactions with others.

The U.S. Food and Drug Administration (FDA) hasn’t approved any specific medications to treat cyclothymia. However, sometimes, providers prescribe a mood stabilizer to help reduce the swings in your mood. These medications may include valproate, lamotrigine and/or lithium.

Can cyclothymia be prevented?

Unfortunately, there’s no known way to prevent cyclothymia because scientists don’t know its exact cause.

However, seeking help as soon as symptoms appear can help decrease the disruptions to your life and relationships.

What is the prognosis for cyclothymia?

The prognosis (outlook) for cyclothymia can vary.

Irritability, emotional reactions and impulsivity often make it difficult for people with cyclothymia to build and maintain positive relationships with family, friends, coworkers and romantic partners.

However, compared to people with bipolar disorder, people with cyclothymia may:

• Have fewer hospitalizations.
• Have fewer days away from work.
• Be able to function more consistently.

For those who do seek help for cyclothymia, early diagnosis and treatment can result in significant improvement in the long-term outlook.

When should I see my healthcare provider about cyclothymia?

If you’re experiencing shifting moods of hypomania and mild depression, it’s important to see a healthcare provider.

If a provider has diagnosed you with cyclothymia, be sure to see your provider and/or therapist regularly for treatment.

A note from Cleveland Clinic

Cyclothymia is usually a lifelong illness. But ongoing treatment, such as talk therapy and medication, can help manage your symptoms and enable you to live a healthy, purposeful life. It’s important to seek medical help if you’re experiencing symptoms of cyclothymia. Know that your providers and loved ones are there to support you.