Definition, Symptoms, Causes & Treatment

Definition
Cyclothymia is a mild form of bipolar disorder, characterized by alternating episodes of mood swings from mild or moderate depression to hypomania. Hypomania is defined as periods of elevated mood, euphoria and excitement that do not cause the person to become disconnected from reality.

A person with cyclothymia experiences symptoms of hypomania but never a full-blown manic episode. Hypomania may feel good to the person who experiences it and may even be associated with better functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

The symptoms are never severe enough to be classified as a major depressive episode. For cyclothymic symptoms to be diagnosed, hypomanic symptoms and depressive symptoms must be present alternately for at least two years. Longitudinal follow-up studies indicate that the risk of bipolar disorder developing in patients with cyclothymia is about 33 percent; although 33 times greater than that for the general population, this rate of risk is still too low to justify viewing cyclothymia as merely an early manifestation of bipolar type I disorder.


Symptoms
For the duration of at least two years (one year for children and adolescents), the individual exhibits presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

Hypomanic symptoms are similar to manic-episode symptoms but are much shorter in duration (a minimum of four days).

Signs and symptoms of mania (or a manic episode), which are similar to those of cyclothymia (or a hypomanic episode), include:

Increased energy, activity and restlessness
Excessively "high," overly good, euphoric mood
Extreme irritability
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can't concentrate well
Need little sleep
Unrealistic beliefs in one's abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol and sleeping medications
Provocative, intrusive or aggressive behavior
Denial that anything is wrong
A hypomanic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for four days or longer. If the mood is irritable, four additional symptoms must be present. A manic episode is diagnosed if the symptoms occur for a period of one week or longer.

An individual may be diagnosed as cyclothymic if:

During the two-year period (one year for younger patients), the above symptoms are not absent for more than two consecutive months.
During the first two years of the condition, the individual has not had a major depressive episode or any manic or mixed manic episodes.
The disorder does not exist only in the context of a chronic psychosis.
Symptoms are not directly a result of a general medical condition or use of substances.
Symptoms result in severely impaired functioning in work, social or personal areas.


Causes
The cause of cyclothymic disorder is unknown. Although the changes in mood are irregular and abrupt, the severity of the mood swings is far less extreme than that seen with bipolar disorder (manic-depressive illness). Unlike bipolar disorder, periods of hypomania do not progress into actual mania, in which the person may lose control over his or her behavior and go on spending binges, engage in highly risky sexual or drug-taking behavior and become detached from reality.

Hypomanic periods are energizing and a source of productivity for some people, while these periods cause others to become impulsive and unconcerned about the feelings of others, which can damage relationships. Because hypomania feels good, people with cyclothymia may not want to treat it.

It is similar to bipolar disorder (manic-depressive illness) but less extreme. The changes in mood are very irregular and abrupt, but the severity of the swings is less.

To understand the causes of cyclothymia, it may be useful to explore the causes of bipolar disorder.

What Causes Bipolar Disorder?

Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.

In addition, bipolar disorder, like other mental illnesses, does not occur because of a single gene. It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to new and better treatments for bipolar disorder.

Treatment
It is informative to explore treatments for bipolar disorder in learning about treatments for cyclothymia.

Treatments for Bipolar Disorder

A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people with the illness have some residual symptoms. Certain types of psychotherapy or psychosocial interventions, in combination with medication, often can provide additional benefit. These include cognitive-behavioral therapy, interpersonal and social rhythm therapy, family therapy and psychoeducation.

Lithium has long been used as a first-line treatment for bipolar disorder. Approved for the treatment of acute mania in 1970 by the U.S. Food and Drug Administration (FDA), lithium has been an effective mood-stabilizing medication for many people with bipolar disorder.

Anticonvulsant medications, particularly valproate and carbamazepine, have been used as alternatives to lithium in many cases. Valproate was FDA approved for the treatment of acute mania in 1995. Newer anticonvulsant medications, including lamotrigine, gabapentin and topiramate, are being studied to determine their efficacy as mood stabilizers in bipolar disorder. Some research suggests that different combinations of lithium and anticonvulsants may be helpful.

According to studies conducted in Finland in patients with epilepsy, valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20.

Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity and abnormal growth of hair. Therefore, a physician should monitor young female patients taking valproate carefully.

During a depressive episode, people with bipolar disorder commonly require additional treatment with antidepressant medication. Typically, lithium or anticonvulsant mood stabilizers are prescribed along with an antidepressant to protect against a switch into mania or rapid cycling. The comparative efficacy of various antidepressants in bipolar disorder is currently being studied.

In some cases, the newer, atypical antipsychotic drugs such as clozapine or olanzapine may help relieve severe or refractory symptoms of bipolar disorder and prevent recurrences of mania. More research is needed to establish the safety and efficacy of atypical antipsychotics as long-term treatments for this disorder.

More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a heritable component. Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes. Scientists are continuing their search for these genes using genetic analytic methods and large samples of families affected by the illness. The researchers are hopeful that identification of susceptibility genes for bipolar disorder, and the brain proteins they code for, will make it possible to develop better treatments and preventive interventions targeted at the underlying illness process.

Researchers are using advanced imaging techniques to examine brain function and structure in people with bipolar disorder. An important area of imaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders. Better understanding of the neural circuits involved in regulating mood states will influence the development of new and better treatments, and will ultimately aid in diagnosis.

I am so happy that I found this site. I don't feel so lost & alone anymore. Thank you xx

hi
my daughter has been diagnosed with cyclothymia, this explains soo many things over soo many years.
i realy feel i need to now handle things {her} in a different manor than i have been used to, i understand now that through the years i have not helped matters at all but through the hard times and argument we did not know she had a condition.i realy want to help her but do not know where to start, as she is headstrong anyway and any offer of support is very likely to be turned down flat followed probably by the frase 'you dont get it. please can anyone give me some advice on how i can slowly start to support and help her without being seen as an ogre.i so want to help and support her but tact will be the major key element.

many thanks

I have a question about cyclothymia and the DSM-V criteria. Do people who have cyclothymia alternate between mild depression and hypomania or do they have times when they have their "normal" mood?

I thought I might have met the criteria for cyclothymia, but feel unsure now. I think I could possibly have ultra-rapid cycling bipolar, but I need to go to a specialist and plan to soon.

My moods can literally go from hypomanic for 30 minutes to an hour and then depressed (quite severely sometimes) and then back to "average" or "normal" again, and hypomanic episode will not occur again for a long time (unfortunately. I love the feeling) and tend to fluctuate between "average" and depressed most of the year.

However, this is where the DSM-V doesn't provide any answers. According to the DSM-V I meet the criteria for bipolar I, because I have had at least 1 severe mixed episode (it only lasted a few hours thought, but felt very scary and the most confusing state of mind I have ever been in) and when I drunk alcohol for the first time in my life a few years ago I had what I have only recently come to realise as a manic state, however that, again, didn't last very long and only lasted a few hours and I awoke to a very depressed mood that lasted a while.

Peace.

The important problem i see about the cyclotimia, is that it's difficult to distinguish the illness from the usual life.
It's like a ship that goes on his line, but embarking on the water, but without never sinking!

It doesn' t produce heavy crysis, so there is not a strong alarm and so the medical cares come very late. But the cyclotimia, after many years, becomes Mayor depression.

Therefore, the best care,is a correct diagnosis when there's the first suspect.
It's better not waiting.

Sorry,

i wrote thinking Dystymia (almost a depression), not Cyclothymia (almost a bipolar disorder). I shall correct as soon as possible.

Thoose are similar in an aspect only: it's not esasy to recognize from the usual life. Maybe the most important danger is just it.

It's ok, thank you for clarifying things.