Cyclothymia and bipolar statistics

Most of us here have probably seen the statistics about one third of people with cyclothymia developing bipolar sometime in their lives. Does anyone know which bipolar? I would guess bipolar 2 because it and cyclothymia involve more rapid cycling.

Hi Dark in the Light!
I've read those statitics, freaked out, cried, worried, cried some more, then surrendered what I simply couldn't control... But I feel you! Been there! And if you're worried and wondering if you might be one of the one third developing BP I or BP II, I sure can feel the reason for your panic and deep fear. I bookmarked an article that helped me understand the difference ... It really depends upon the intensity of your mania, not necessarily how rapidly you're cycling.(obviously not a doc) If your mania requires hospitalization, then the cyclothymia may develop into BP 1 if the mania is more intense and euphoric than hypomania, then I suppose that's BP 2?? I'm ignorant here... It does make sense though, in the spectrum of things, that we would move from from cyclothymia to BPII, enjoy menopause and BPII would go away completely!! Heehee!! Lemme copy paste what I found pertinent for us... Hope this helps. And hope you can get to your pdoc soon. Will be thinking of you! Big hugs!!

Manic symptoms cover a spectrum of severity from cyclothymia to severe delusional mania. Cyclothymia, which usually starts in adolescence or early adulthood, describes fluctuations of mood between mild elation and depression. Although mild elation of this type may be associated with enhanced personal and social functioning, cyclothymia can also lead to considerable social or  interpersonal difficulties because of its unpredictability. A proportion of cyclothymic individuals go on to develop mania. Bipolar 
disorder is characterised by clinically marked mood swings between mania and depression. The DSM classification further  differentiates between bipolar I (BPI) and bipolar II (BPII) disorders. Mania is characteristic of BPI, while mild mania or hypomania  (not requiring hopitalisation) is characteristic of BPII. Unipolar mania describes recurrent episodes of mania in the absence of depressive illness. It is uncommon and otherwise resembles bipolar disorder. Secondary or induced mania describes manic symptoms or syndromes that are seen in various organic conditions. Finally, there are conditions which lie between the schizophrenias and affective disorders, so-called schizo-affective disorders. When manic symptoms are the predominant mood component, these disorders tend to pursue a course similar to that of manic-depressive illness rather than schizophrenia.2 

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Clinical Description and Diagnosis

An episode of mania may begin abruptly, over the space of a few hours or days, or gradually, over some weeks. The subjective experience of mania in its minor forms usually includes heightened feelings of well-being with increased alertness and drive, inflated self-esteem, and expansive sociability. In addition to a general elevation of mood, instability or lability is typical. Irritability may easily be evoked, and other mood states such as anxiety or sadness, fleetingly but intensely expressed, may become apparent. In mixed 
mood states (also referred to as dysphoric mania), pronounced symptoms of both depression and mania either coexist or alternate during different periods of the day. As mania deepens, overactivity and overtalkativeness become more obvious. Grandiose ideas and plans, and grandiose delusions may develop. Overspending or socially embarrassing behaviour can be a source of great distress to  the family and the recovering patient. Up to two-thirds of patients experience psychotic symptoms at some time. Delusions occur more commonly than hallucinations, but ideas of reference or even experiences of possession or control, may also be seen. In most  cases these symptoms are transient, their content reflects the underlying mood, and the diagnosis remains clear. 

 The differential diagnosis of mania includes schizophrenia, drug-induced states, and organic disorders. It is sometimes difficult to  distinguish between mania and schizophrenia, especially if psychotic symptoms are prominent, incongruent with the underlying mood, or persist after the overactivity subsides. Such diagnostic difficulties are commonly found in cases presenting in adolescence. When affective and schizophrenic symptoms are evenly balanced and prominent enough such that a diagnosis of each can be made 
independently, then the term schizo-affective disorder is used. Kraepelin’s original distinction between schizophrenic and affective diagnoses was founded on both cross-sectional data and longitudinal course, and the need to maintain this dual perspective remains. Quite frequently, it is only over a prolonged period of observation that the diagnosis can be established with reasonable certainty. Drug-induced states and organic conditions must also be included in the differential diagnosis. Steroids, stimulants, and  antidepressants are known to induce manic symptoms and a large variety of other drugs have al so been implicated. Secondary mania can occur due to a variety of neurological lesions and metabolic or other states affecting brain functioning. Although late-onset cases of mania do occur, the likelihood of organic causation should always be considered, especially in the absence of a past or a family history of affective disorder. Sometimes the delirium of severe mania can itself resemble that of an acute confusional state. Alcohol and other substance abuse are important co-morbid conditions, and their intake-often escalates during acute episodes of mania,  sometimes masking or clouding the presentation. 

Wow, that's a lot to take in. That's going to take a while to soak up.

My idea about what might be happening: In the cyclothymic, the mood and energy states rise and fall because of a somewhat slow regulator, like a boat operator who's not able to maintain a constant speed. When the energy state is going up, whatever regulation is supposed to keep it from going too high takes longer than it should to work. Likewise, when the energy state goes down, whatever is supposed to tug it back up doesn't begin to work until later than it should. For that to progress to bipolar, the regulator could take even longer to work.

The big question is why it takes longer to work. Is it taking longer to start working? Then it's like a boat that gets up to full speed and keeps going a while the helmsman throttles down. When it gets to hull stop, it takes a while for the helmsman to throttle up again. If this analogy is used to explain how cyclothymia becomes bipolar, the helmsman is taking even longer to start throttle up or down.

Or is it working all along, just not very strongly? The boat speeds up faster than it should and the helmsman throttles down but he doesn't throttle down enough. And when it's too slow, he throttles up but not up enough. So there's always a lag. In this analogy, cyclothymia becomes bipolar when the helmsman makes even slower adjustments.

I suspect the second explanation because chemical reactions happen quickly. But there may not be enough of a reaction to get the desired effect if not enough of the chemical is where it's supposed to be or if there's too much of something else interfering with the reaction. Someday, scientists will invent brain scans that can tell for sure. Maybe the DSM-6 will define different types of bipolar (or whatever it's called then) that way.

DISCLAIMER: I am not a doctor.