# Cyclothymia: Symptoms, causes, diagnosis, and treatment



## David Baxter PhD (Nov 13, 2007)

Cyclothymia
By Mayo Clinic Staff 
Apr 19, 2006 

Cyclothymia, or cyclothymic disorder, is a chronic mood disorder that results in short periods of mild emotional and behavioral "highs" alternating with short periods of mild to moderate depression. People with cyclothymia also experience intermittent periods of emotional and behavioral stability.

Cyclothymia is a less severe form of bipolar disorder, the latter of which results in extreme swings between manic or hypomanic episodes and major depressive episodes. Although people with cyclothymia may develop bipolar disorder, the less severe condition isn't simply the onset or an early alert of the more severe condition.

The estimated prevalence of cyclothymia is between 0.4 percent and 1 percent of the general population in the United States. It usually begins during adolescence or early adulthood.

*Signs and symptoms*
The symptoms of cyclothymia are essentially the same as those of bipolar disorder, but they're less severe and the episodes of highs and lows are generally shorter in duration.

*Hypomania*
Mania is the extreme "high" of bipolar disorder. The term "hypomania" ? or "beneath mania" ? refers to manic-like symptoms that fall short of mania in severity. Hypomanic symptoms may be present in both bipolar disorder and cyclothymia.

A key feature of hypomania is the presence of at least one of the following:


Unusually good mood or cheerfulness (euphoria) 
Unusual enthusiasm for interpersonal or social interactions 
Irritability or angry outbursts
Other hypomanic signs and symptoms include:


Inflated self-esteem or grandiosity 
Decreased need for sleep 
Nearly constant talking 
Racing thoughts 
Tendency to be distracted 
Driven engagement in work, relationships or hobbies 
Physical agitation 
Excessive involvement in pleasurable or risky activities
*Depression*
A key feature of mild to moderate depression in cyclothymia is either:


Persistent feelings of sadness or, in children, persistent irritability 
Diminished interest or pleasure in all or most activities
Other signs and symptoms of depression include:


Change in weight 
Difficulty sleeping 
Excessive sleeping 
Physical agitation or physical slowing down 
Loss of energy 
Difficulty concentrating or making decisions 
Thoughts of death or suicide
*Impact of symptoms on function*
The hypomanic and depressive episodes of cyclothymia generally don't prevent people with the disorder from engaging in their normal activities at work or school or in social situations. However, the unpredictable nature of cyclothymia, the sudden shift to a hypomanic or depressive period, and behaviors associated with these moods can significantly disrupt your life.

The constant cycling between stable and symptomatic mood states often leads to short-lived or strained relationships, insecure self-identity, job instability, uneven performance in school, a history of ambitious but unfulfilled endeavors, or patterns of risky behaviors in sexual encounters or drug and alcohol use.

*Causes*
Doctors and researchers don't know the exact cause of cyclothymia, but studies have shown that a combination of genetic, biological and environmental factors may lead to the disorder or influence susceptibility to it.

Researchers are searching for variant genes that may increase the risk of developing cyclothymia. Identification of these genes may eventually reveal how their protein products contribute to dysfunction in brain cell networks related to mood. Investigators are also examining the influence of a moody temperament at birth, disturbances in the sleep-wake cycle, stressful life events, or family and social environments as potential contributing factors.

*When to seek medical advice*
People with cyclothymia aren't likely to recognize signs and symptoms of the disorder, and in particular, they may not perceive problems associated with their hypomanic phases. If a friend or family member experiences cycles of hypomania and depression that disrupt work or relationships, you might suggest that the person see a doctor to discuss how to cope more effectively with depression or distress.

If you're thinking of hurting yourself, seek help at an emergency room. If you're having relationship or work conflicts, feelings of depression, or other feelings that disrupt your ability to function well, see your doctor to find the underlying cause and to seek treatment.

*Screening and diagnosis*
A diagnosis is most often made by a psychotherapist ? usually a psychiatrist, psychologist or licensed clinical social worker. In addition to interviewing the individual who may have cyclothymia, the psychotherapist may depend on interviews with significant others. Because most people with cyclothymia seek medical advice for depressive symptoms, evidence of hypomanic episodes may not be readily apparent to the therapist in initial interviews.

A therapist will make a diagnosis of cyclothymia if:


There's evidence of numerous periods of hypomania and numerous periods of mild to moderate depression for at least two years in adults or one year in children and adolescents 
Intermittent periods of stable mood haven't lasted longer than two months 
There's no evidence of a manic episode or major depressive episode 
Certain psychiatric disorders, such as schizoaffective disorder, have been ruled out as more likely causes of the symptoms 
The symptoms aren't the direct effect of substance abuse or a medical condition, such as a thyroid disorder 
The symptoms cause significant distress or functional impairment in social, interpersonal or work situations
*Complications*
Cyclothymia shares many symptoms with other psychiatric disorders, and it may even coexist with these same disorders. Subsequently, a diagnosis may change or evolve over time. These other disorders include:


Attention-deficit/hyperactivity disorder (ADHD) 
Borderline personality disorder 
Substance abuse
People with cyclothymia are also at risk of experiencing major depressive or manic episodes. Studies have shown that between 15 percent and 50 percent of people with cyclothymia develop bipolar disorder.

*Treatment*
Treatment strategies for cyclothymia are based primarily on the recommended practices for treating bipolar disorder.

*Medications*
Medications may help some people with cyclothymia to regulate their moods and prevent periods of hypomania and depression. Most people need to continue such treatments for the rest of their lives. Medications commonly prescribed include:


Lithium (Eskalith, Lithobid) 
Anticonvulsants, such as valproic acid (Depakene), divalproex (Depakote) and carbamazepine (Carbatrol, Tegretol) 
Antipsychotics, such as risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel
) 
Some people experience serious side effects that may limit or preclude the use of drug treatments. Long-term use of lithium is associated with kidney, thyroid and cardiovascular damage. While antipsychotic drugs are often effective in regulating hypomania, they may induce depression. Some antipsychotics may also increase the risk of developing diabetes or cardiovascular disorders.

Your doctor may prescribe antidepressants, but they may trigger hypomania or mania. Use of antidepressants is more likely reserved for the major depressive symptoms associated with bipolar disorder.

*Medications for children and adolescents*
Studies provide very little information about the effectiveness of drug treatments for children and adolescents with cyclothymia or bipolar disorder. Your doctor may prescribe mood-stabilizing drugs based on modified guidelines for treating adults.

Two risk factors are notable. Common drug treatments for ADHD may worsen hypomanic symptoms. This factor is a particular problem if there is a misdiagnosis or if a child has both cyclothymia and ADHD.

Studies have shown that valproic acid (Depakene), divalproex (Depakote) and generic valproate may increase testosterone levels in teenage girls. This side effect can lead to ovarian cysts, disrupted menstrual cycles, obesity and abnormal hair growth.

*Psychotherapy*
The goals of psychotherapy are to help the person with cyclothymia:


Understand the nature of the disorder and learn to seek help when necessary 
Modify thoughts or behaviors that exacerbate or trigger symptoms 
Learn to live with extremes in mood 
Create manageable daily routines 
Improve choices and interactions in interpersonal and social relationships
A psychotherapist may also recommend family therapy to help each family member deal with distress related to cyclothymia and to develop coping strategies.

*Self-care*
The following recommendations may help you manage cyclothymic symptoms:


*Take your medications*. Even if you're feeling well, follow your doctor's orders. Discontinuing treatment can lead to a hypomanic or depressive episode. 
*Pay attention to warning signs*. If you feel you're facing a symptomatic episode, call your doctor and take preventive action, such as simplifying your schedule. Involve family members or friends in watching for warning signs. 
*Be aware of triggers*. Avoid triggers when possible and develop strategies to deal with those you can't avoid. You may be able to work around some challenging situations or find optimal times to deal with them. 
*Avoid drugs and alcohol*. Drugs and alcohol may trigger hypomania or depression. 
*Check first before taking other medications.* Call the doctor who's treating you for cyclothymia before taking other prescription drugs, over-the-counter medications or dietary supplements. Some of these substances may trigger cyclothymic symptoms or interact with your mood-stabilizing medications. 
*Keep a record of your moods, daily routines and significant life events*. These records may help you and your psychotherapist understand the effect of treatments and identify thinking patterns and behaviors associated with cyclothymic symptoms. 
*Keep regular work, mealtime, sleep, social and exercise routines*. A consistent daily routine may help prevent rapid shifts in mood. 
*Join a support group*. Local chapters of nonprofit organizations, such as the Depression and Bipolar Support Alliance, provide support groups that offer an empathetic environment and help individuals and families learn new coping strategies.


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## moody-one (Dec 1, 2007)

Thanks David for your very good account of cyclothymia. I was diagnosed 2 yrs. ago, with bi-polar 1, my shrink put me on valproic acid, and some anti-depressant. I had very bad side-effects from these drugs, it made me much worse. I never really believed I had bi-polar, so after being on the meds. for 3 months, I weaned myself off of them. I then felt great, like my old self.
It was about a month ago, when I was seeing my Internist(for my thyroid) bloodwork results, that my Dr. thought I may have cyclothymia. Now since I've researched this, I do believe this is what I have. I am on no meds. at this point, I just started a mood chard for myself to track my moods. I feel I can deal with this, as I do meditate daily, and do work-out at a gym 3x a week also.
The stress is down for me, as I'am on a disability for fibromyalgia, and OA. and Crohn's disease.
What scares me the most, is that I have read that you still have a good chance of becoming bi-polar in the future, or if a tramatic event happens...
I don't want to worry about that now, as I feel I have my life under control, and don't feel any need to go on any medication for this, at this time.


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## David Baxter PhD (Dec 1, 2007)

I'm only the poster. The article came from the Mayo Clinic, one of many excellent client summaries.


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## moody-one (Dec 1, 2007)

I'am new here...it was a good understanding of cyclothymia for me anyway:


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## prayerbear (Feb 13, 2008)

That was my diagnosis after taking 160 mg. of Geodon. This is the most stable I have ever been as far as I can remember. I am also OCD, so having my mood not go up and down has really calmed the severe anxiety. I am also not "seeing things" that aren't there. A psychiatrist told me that people with major OCD occassionally see things that aren't there. I sure don't anymore!

   Interestingly, my doctor thought I was bipolar II before putting me on Geodon and then after all that medicine labeled me cyclothmic. Sound typical?

                                            miss ex-clean


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## rosedragon (Feb 14, 2008)

Except the parts around hurting self such as drug abuse, alcohol abuse, or thinking of suicide, seems I have all other signs and symptoms.. o..ow...



> Keep regular work, mealtime, sleep, social and exercise routines. A consistent daily routine may help prevent rapid shifts in mood.



My schedule very chaotic.. :/


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## moody-one (Feb 14, 2008)

Thanks Prayerbear....I not familiar with the drug your taking, are you from the U.S.? I'am Canadian, I will look up that drug, as curious now, to what it is...
Have a happy V-day.....


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## Retired (Feb 14, 2008)

Here is a link to the Pfizer homepage for Geodon:

Schizophrenia and Bipolar Mania Treatment - Geodon


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## David Baxter PhD (Feb 14, 2008)

Moody-one, Geodon is a medication that has been available in the US for some time and just very recently was approved by Health Canada for sale here. It is in the same family as Seroquel, Zyprexa, etc., medications generically given the unfortunate name of "atypical anti-psychotics". I say "unfortunate" because although they are used in the treatment of schizophrenia and related illnesses they are also used in the treatment of bipolar disorder, anxiety, depression, etc.


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## moody-one (Feb 14, 2008)

Thanks for the info on Geodon, I already went and looked it up, on the computer...scary drug with many side-effects.....especially if you have any heart issues, or irregular heatbeat, which I do get at times..with my thyroid.

Don't think I'll be trying this drug., but thanks for the info.


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## Retired (Feb 14, 2008)

Moody-One,



> scary drug with many side-effects



Without a complete medical history taken by a specialist, no one can say if a particular medication might have benefit in treating one's condition.

Once a diagnosis is made, treatment options are considered on a benefits vs risks basis.

All medications can have adverse (side) effects, and there is no medication which is 100% side effect free. Some side effects go away with time as the body becomes acclimated to the new medication, while others may or may not persist.  Side effects are compared to how people might react if they were taking placebo (in the research studies) as people experience some side effects even when taking placebo.

Side effects are reported in percentages of population who take the medication, so if, say, 5% of people experience a given side effect, the benefits of the medication would likely outweigh the disadvantages.

However if 90% of people experience a given side effect, the medication would have to have an outstanding success rate to justify its use.

Sometimes, however there are absolute contraindications which preclude the use of certain medications in people with specific conditions. 

Your doctor is your best resource to help evaluate your treatment options


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## moody-one (Feb 15, 2008)

Thanks for your info TSOW. Right now, I am not looking for any treatment, but I'll remember your advice when I do though.
One thing at a time for me, I'am trying to quit smoking, with that new drug ''Champix'', it has side-effects of nausea and headaches for me....but I sure want to quit......Kathy


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## Retired (Feb 15, 2008)

Please keep us posted on your progress with your smoking cessation.  

Regards,


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## moody-one (Feb 16, 2008)

I'am still taking the ''Champix'' to try to kick this habit of smoking. It does seem to make you not want to smoke as much, but getting side-effects of nausea and headaches.
On top of that, I'am on day 3 now, with the flu..so not feeling too great at all.
Going to try to shower today(that will be a feat for me, as just so exhausted with this flu) Maybe it will make me feel better(I hate dirty hair)
I'll keep you posted, on my progress.


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