MENTAL HEALTH Mental Disorders • Compulsive sexual behavior • Schizophrenia • Bipolar disorder • Borderline personality disorder • Compulsive gambling • Body dysmorphic disorder • Personality disorders • Dissociative disorders • Narcissistic personality disorder • Cyclothymia • Intermittent explosive disorder • Self-injury/cutting • Antisocial personality disorder • Schizotypal personality disorder

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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.

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.

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.

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.

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

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 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.

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.