Cyclothymia (cyclothymic disorder)

Overview

Cyclothymia (sy-kloe-THIE-me-uh), also called cyclothymic disorder, is a rare mood disorder. Cyclothymia causes emotional ups and downs, but they're not as extreme as those in bipolar I or II disorder.

With cyclothymia, you experience periods when your mood noticeably shifts up and down from your baseline. You may feel on top of the world for a time, followed by a low period when you feel somewhat down. Between these cyclothymic highs and lows, you may feel stable and fine.

Although the highs and lows of cyclothymia are less extreme than those of bipolar disorder, it's critical to seek help managing these symptoms because they can interfere with your ability to function and increase your risk of bipolar I or II disorder.

Treatment options for cyclothymia include talk therapy (psychotherapy), medications and close, ongoing follow-up with your doctor.

Symptoms

Cyclothymia symptoms alternate between emotional highs and lows. The highs of cyclothymia include symptoms of an elevated mood (hypomanic symptoms). The lows consist of mild or moderate depressive symptoms.

Cyclothymia symptoms are similar to those of bipolar I or II disorder, but they're less severe. When you have cyclothymia, you can typically function in your daily life, though not always well. The unpredictable nature of your mood shifts may significantly disrupt your life because you never know how you're going to feel.

Hypomanic symptoms

Signs and symptoms of the highs of cyclothymia may include:

• An exaggerated feeling of happiness or well-being (euphoria)
• Extreme optimism
• Inflated self-esteem
• Talking more than usual
• Poor judgment that can result in risky behavior or unwise choices
• Racing thoughts
• Irritable or agitated behavior
• Excessive physical activity
• Increased drive to perform or achieve goals (sexual, work related or social)
• Decreased need for sleep
• Tendency to be easily distracted
• Inability to concentrate

Depressive symptoms

Signs and symptoms of the lows of cyclothymia may include:

• Feeling sad, hopeless or empty
• Tearfulness
• Irritability, especially in children and teenagers
• Loss of interest in activities once considered enjoyable
• Changes in weight
• Feelings of worthlessness or guilt
• Sleep problems
• Restlessness
• Fatigue or feeling slowed down
• Problems concentrating
• Thinking of death or suicide

When to see a doctor

If you have any symptoms of cyclothymia, seek medical help as soon as possible. Cyclothymia generally doesn't get better on its own. If you're reluctant to seek treatment, work up the courage to confide in someone who can help you take that first step.

If a loved one has symptoms of cyclothymia, talk openly and honestly with that person about your concerns. You can't force someone to seek professional help, but you can offer support and help find a qualified doctor or mental health provider.

Suicidal thoughts

Although suicidal thoughts might occur with cyclothymia, they're more likely to occur if you have bipolar I or II disorder. If you're considering suicide right now:

• Call 911 or your local emergency services number, or go to a hospital emergency department.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

If you just can't make that call, reach out to someone else — immediately — such as your doctor, mental health provider, family member, friend or someone in your faith community.

Causes

It's not known specifically what causes cyclothymia. As with many mental health disorders, research shows that it may result from a combination of:

• Genetics, as cyclothymia tends to run in families
• Differences in the way the brain works, such as changes in the brain's neurobiology
• Environmental issues, such as traumatic experiences or prolonged periods of stress

Risk factors

Cyclothymia is thought to be relatively rare. But true estimates are hard to make because people may be undiagnosed or misdiagnosed as having other mood disorders, such as depression.

Cyclothymia typically starts during the teenage years or young adulthood. It affects about the same number of males and females.

Complications

If you have cyclothymia:

• Not treating it can result in significant emotional problems that affect every area of your life
• There is a high risk of later developing bipolar I or II disorder
• Substance misuse is common
• You may also have an anxiety disorder
• You may be at increased risk of suicidal thoughts and suicide

Prevention

There's no sure way to prevent cyclothymia. However, treatment at the earliest indication of a mental health disorder can help prevent cyclothymia from worsening. Long-term preventive treatment also can help prevent minor symptoms from becoming full-blown episodes of hypomania, mania or major depression.

Diagnosis

Your doctor or other health care provider must determine if you have cyclothymia, bipolar I or II disorder, depression, or another condition that may be causing your symptoms. To help pinpoint a diagnosis for your symptoms, you'll likely have several exams and tests, which generally include:

• Physical exam. A physical exam and lab tests may be done to help identify any medical problems that could be causing your symptoms.
• Psychological evaluation. A doctor or mental health provider will talk with you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms, such as possible hypomanic or depressive symptoms.
• Mood charting. To identify what's going on, your doctor may have you keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.

Diagnostic criteria

For a diagnosis of cyclothymia, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these points:

• You've had many periods of elevated mood (hypomanic symptoms) and periods of depressive symptoms for at least two years (one year for children and teenagers) — with these highs and lows occurring during at least half that time.
• Periods of stable moods usually last less than two months.
• Your symptoms significantly affect you socially, at work, at school or in other important areas.
• Your symptoms don't meet the criteria for bipolar disorder, major depression or another mental disorder.
• Your symptoms aren't caused by substance use or a medical condition.

Treatment

Cyclothymia requires lifelong treatment — even during periods when you feel better — usually guided by a mental health provider skilled in treating the condition. To treat cyclothymia, your doctor or mental health provider works with you to:

• Decrease your risk of bipolar I or II disorder, because cyclothymia carries a high risk of developing into bipolar disorder
• Reduce the frequency and severity of your symptoms, allowing you to live a more balanced and enjoyable life
• Prevent a relapse of symptoms, through continued treatment during periods of remission (maintenance treatment)
• Treat alcohol or other substance use problems, since they can worsen cyclothymia symptoms

The main treatments for cyclothymia are medications and psychotherapy.

Medications

No medications are approved by the Food and Drug Administration specifically for cyclothymia, but your doctor may prescribe medications used to treat bipolar disorder. These medications may help control cyclothymia symptoms and prevent periods of hypomanic and depressive symptoms.

Psychotherapy

Psychotherapy, also called psychological counseling or talk therapy, is a vital part of cyclothymia treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful, such as:

• Cognitive behavioral therapy (CBT). A common treatment for cyclothymia, CBT focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your symptoms. You also learn effective strategies to manage stress and cope with upsetting situations.
• Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for better mood management. People with mood disorders may benefit from establishing a daily routine for sleep, meals and exercise.
• Other therapies. Other therapies have been studied with some evidence of success. Ask your doctor if any other options may be appropriate for you.

Lifestyle and home remedies

In addition to professional treatment, you can build on your treatment plan by following these lifestyle and self-care steps:

• Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, cyclothymia symptoms are likely to come back.
• Pay attention to warning signs. You may have identified a pattern to your cyclothymia symptoms and what triggers them. Follow your treatment plan if you feel you're facing a period of high or low symptoms. Involve family members or friends in watching for warning signs. Addressing symptoms early may keep them from getting worse.
• Quit drinking or using recreational drugs. Alcohol and recreational drugs may trigger mood changes. Talk to your doctor if you have trouble quitting on your own.
• Check first before taking other medications. Call the doctor who's treating you for cyclothymia before you take over-the-counter medications or medications prescribed by another doctor. Sometimes other medications trigger periods of cyclothymia symptoms or may interfere with medications you're already taking.
• Keep a record. Track your moods, daily routines and significant life events. These records may help you and your mental health provider understand the effect of treatments and identify thinking patterns and behaviors associated with cyclothymia symptoms.
• Get regular physical activity and exercise. Moderate, regular physical activity and exercise can help steady your mood. Working out releases brain chemicals that make you feel good (endorphins). It can also help you sleep and has a number of other benefits. Check with your doctor before starting any exercise program.
• Get plenty of sleep. Don't stay up all night. Instead, get plenty of sleep. Sleeping enough is an important part of managing your mood. If you have trouble sleeping, talk to your doctor or mental health provider about what you can do.

Coping and support

Coping with cyclothymia can be difficult. During periods when you feel better, or when you're having hypomanic symptoms, you may be tempted to stop treatment. Here are some ways to cope with cyclothymia:

• Learn about the disorder. Learning about cyclothymia and its possible complications can empower you and motivate you to stick to your treatment plan. Also, you can help educate your family and friends about what you're going through.
• Join a support group. Ask your provider if there's any type of support group that might help you reach out to others facing similar challenges.
• Stay focused on your goals. Successfully managing cyclothymia can take time. Stay motivated by keeping your goals in mind.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
• Learn relaxation and stress management. Try relaxation methods or stress-reduction techniques such as meditation and yoga.

Preparing for an appointment

If you have signs and symptoms common to cyclothymia, call your doctor. After your initial appointment, your doctor may refer you to a mental health provider who can help make a diagnosis and create the right treatment plan for you.

You might want to ask a trusted family member or friend to come to your appointment, if possible. Someone close to you may provide additional insight about your condition and can help you remember what's discussed during your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you've been experiencing, and for how long
• Your medical information, including other physical or mental health conditions with which you've been diagnosed
• Any medications you're taking, including over-the-counter medications, vitamins and supplements, and their doses
• Questions to ask your doctor or mental health provider to make the most of your time together

Questions may include:

• What do you believe is causing my symptoms?
• Are there any other possible causes?
• How will you determine my diagnosis?
• What treatments are likely to be helpful in my case?
• How much do you expect my symptoms to improve with treatment?
• Will I need to be treated for the rest of my life?
• What lifestyle changes can help me manage my symptoms?
• How often should I be seen for follow-up visits?
• Am I at increased risk of other mental health problems?
• Do you have printed material that I can have? What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your doctor or mental health provider may ask:

• How would you describe your symptoms?
• How have the people close to you described your symptoms?
• When did you or your loved ones first notice these symptoms?
• Have your symptoms been getting better or worse over time?
• If you have intense high and low periods, how long do they generally last?
• Do you also have periods where your mood feels relatively stable?
• How would you describe your mental and emotional state during high versus low periods? How would your loved ones answer this question about you?
• How would you say your choices and behaviors change during high versus low periods? How would your loved ones answer this question about you?
• Do your physical needs change during high versus low periods, such as your need for sleep, food or sex?
• How are these cycles affecting your life, including work, school and relationships?
• Have any of your close relatives had similar symptoms?
• Have you been diagnosed with any medical conditions?
• Have you been treated for other mental health disorders in the past? If yes, what type of treatment was most helpful?
• Have you ever thought about harming yourself or others?
• Do you drink alcohol or use recreational drugs? If so, how often?