Cyclothymic Disorder

(Cyclothymia)

The Facts

Cyclothymic disorder, also called cyclothymia, is a type of mood disorder where people experience numerous periods of mood "highs" and "lows" that are unrelated to life circumstances. The mood instability – mild elation or mild depression – is related to bipolar disorder (which was formerly known as manic depression) and is in fact considered to be a milder form of bipolar disorder. Though less severe, cyclothymia can have a great impact on a person's life, where unexpected and extreme mood changes disrupt the ability to function normally.

Both men and women are equally likely to suffer from cyclothymia, affecting up to 1% of the population. Cyclothymic disorder generally starts appearing during young adulthood, though it may also first occur at a later age.

The Causes

The exact causes of cyclothymia are not known, but it is often a result of the same genetic factors that cause bipolar disorder. In fact, there is an estimated 15% to 50% risk that people with cyclothymia will eventually be diagnosed with bipolar disorder following a full-blown manic episode or major depression.

People with cyclothymic disorder usually have a family history of major depression, bipolar disorder, suicide, or alcohol or drug dependence.

Symptoms And Complications

Radical changes in mood and behaviour (alternating between highs and lows) are typical signs of cyclothymia.

During a mood "high," the person may feel very optimistic and cheerful and may have an increased drive to reach their goals. Unfortunately, this is often coupled with poor judgment, racing thoughts, difficulty concentrating, and sometimes even aggressive behaviour. The "highs" of cyclothymia are similar to those of bipolar disorder but are less severe. In some cases, this mood elation may dominate a person's mood, and this is known as chronic hypomania.

During a mood "low," the person has symptoms similar to depression: feeling sad and hopeless, losing interest in things they used to enjoy, feeling guilty or worthless, having trouble concentrating, thinking of suicide, and having problems with eating or sleeping. The "lows" of cyclothymia are similar to those seen in mild-to-moderate depression.

This continual - and unpredictable - mood cycling often takes its toll on an individual's life, even though altered mood episodes aren't as extreme as with bipolar disorder. Mood changes make it difficult to sustain enthusiasm for new projects or for work. Personal relationships tend to suffer from the "warm-cool" ups and downs of the person's mood. Over time, mood cycling can lead to repeated loss of employment and may become destructive to personal relationships.

Making A Diagnosis

Doctors may consider a diagnosis of cyclothymia if there is a history of mood instability for a period of at least 2 years, and symptom-free intervals never last more than 2 months. For children and adolescents, symptoms only need to be present for a one-year period.

Cyclothymia will otherwise be difficult to diagnose if a person's mood instability has not been recognized and tracked over at least a couple of years. Because mood may be normal and stable for long periods of time - mood elevations or depressions can be quite mild - symptoms do not always attract medical attention. People may not look for help until symptoms and mood swings become severe enough to interrupt normal functioning and activities.

If a person has experienced major depressive, manic, or mixed episodes, the diagnosis will likely be changed to bipolar disorder. Your doctor will usually also need to rule out other conditions, as these symptoms could be caused by substance abuse, physiological effects of certain medications, or an unrelated medical condition.

Treatment And Prevention

Medical options for treating cyclothymia include psychotherapy and medications. Medications for cyclothymia include lithium, a mood stabilizer that is also used in the treatment of bipolar disorder.* Lithium can reduce the frequency of mood cycling and keep moods more balanced. Other medication options include antipsychotic medications and certain antiseizure medications, which are used for mood stabilizing effects. Antidepressants should be avoided unless depression is severe and has lasted a long time, as they can cause rapid cycling (switching from one mood to the other), which can be risky. Support groups may help people with cyclothymia to share their common concerns and experiences.

Because symptoms can be mild, it is possible that cyclothymia might never be diagnosed. It is also possible that it does not necessarily require treatment. In fact, a degree of hypomania may be responsible for a person's success in life, whether it is business or leadership drive, or other achievements. For this reason, the decision to use a mood stabilizer should be made by weighing negative effects on their functioning against any positive effects of hypomania.

However, for those who have a family history of bipolar disorder or who are at risk for a depressive episode, the symptoms may hit them hard and have drastic consequences. In such cases, awareness of cyclothymic and bipolar disorders, coupled with medical monitoring, can help prepare the individual for these episodes and ensure they get prompt and effective treatment.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.