Euthymia lies between extreme moods, such as depression and mania.
A person is often regarded as when in the longitudinal course of mood disturbances, the threshold of a disorder is not met. People with bipolar disorder may spend most of their time in the state of mania, depression, or in a mixed state, while the rest are in euthymia.
Certain mechanisms that lead to depressive episodes and acute mania have been identified. They include neurotransmitter alterations, structural abnormalities, and disturbances in sleep. However, in psychological distress, many fluctuations were found and recorded, particularly in longitudinal studies. The findings suggested that even though the intensity of the disorder may vary, the illness remains to be always active.
In these patients, consistent findings have been reported along with socioeconomic, psychosocial, and clinical deterioration. Thus, the question is whether a person is really in the state of euthymia during the subthreshold symptomatic periods or just a manifestation, or a part of the disorder. Moreover, in biological measurements, there were considerable variations that occurred, which further increased the doubts. Additionally, the same things are considered for euthymia in the state of dysthymia and unipolar depression.
What is euthymia?
Euthymia refers to a normal and tranquil mood. Usually, during medical exams, people are said to have a euthymic mood when a positive mood is displayed instead of extreme sadness or happiness. This stable mood is also often associated with bipolar disorder.
Euthymia also lies between extreme moods, such as depression and mania. For this reason, it is simply regarded as a state of stable or normal mood. People with other types of mood disorders, such as dysthymia, may also experience euthymia. The state of euthymia also fades due to anxiety, depression, or both. In order to achieve a balanced mood, most patients with these mood disorders are treated using prescription medications.
Origin of the concept of euthymia
The word euthymia originated from the Greek word eu, which means well, and thymos meaning emotion or soul. There are also four different meanings of the latter word and they are:
- Life energy
- Feelings and passions
- Will, desire, and inclination
- Thought and intelligence
The most interesting thing is that the verb of euthymia, called euthymeo, means that a person is both happy and in good spirits. A Greek philosopher named Democritus was the first one to define the word.
Democritus stated that euthymia means that a person is satisfied with whatever is available and is present, paying less heed to those who envy, and admire others who are suffering yet enduring. He said that it is a state in which satisfaction is experienced with balanced emotions and defeated fears.
The Greek definition of euthymia was also translated by a Latin philosopher named Seneca with tranquillitas animii, which means a state of internal calm and contentment. He also stated that happiness is not everything and that a person should also be aware of his or her well-being (felicitatis intellectus). However, Plutarch's writings criticized the concept of euthymia, which involved a detachment from current events in life. It took a long time before all of these concepts were clinically accepted.
In 1958, an extraordinary book about positive mental health was published by Marie Jahoda, who denied the identification of mental health with the absence of a disease. She outlined the following criteria for positive mental health:
- Environmental mastery
- Satisfactory interactions with other people and the milieu
- The individual's personal style
- The degree of growth, development, or self-actualization of a person
- Self-perception or acceptance
Identifying a euthymic mood
Knowing how to correctly identify euthymia is important when trying to distinguish between states of depression or mania. When a person is in a state of euthymia, his or her mood is described as steady, calm, and happy.
Although euthymia tends to vary from one person to another, there are common signs that indicate a euthymic mood, and they include:
- Feeling calm
- Moderately enthusiastic
Euthymia and anhedonia
Euthymia and anhedonia are also related to each other. A person showing symptoms of anhedonia may be diagnosed as euthymic.
Anhedonia is a state in which the ability to feel pleasure is reduced. It means that certain activities, such as sex, eating, or touching, does not give pleasure to an individual. Such people from social situations do not gain any pleasure as well. The following are some of the symptoms experienced by a person with anhedonia:
- Isolation or social withdrawal
- Inclined to show fake emotions
- Make excuses to avoid social situations
- Possess negative feelings to oneself or other people
- Reduced verbal and nonverbal expressions
- Low sex drive
- A persistent feeling of being unwell
All of these symptoms can also indicate symptoms of depression, which means that anhedonia can also be experienced during periods of depression. The use of antidepressants and social support tend to be beneficial.
Euthymia and anxiety
In people with bipolar disorder, euthymia can occur along with anxiety. The symptoms of anxiety may vary in every individual. Certain disorders such as panic disorder, generalized anxiety disorder, agoraphobia, obsessive-compulsive disorder, social anxiety disorder, and post-traumatic stress disorder show symptoms of anxiety. It could be possible that symptoms of anxiety may have developed along with bipolar disorder or may have developed after bipolar disorder is treated. It is very common to find euthymia and anxiety disorders coexisting in a person. According to research, it was found that many people met the diagnostic criteria of both anxiety disorders and bipolar euthymia.
It is still unknown as to why some people with bipolar disorder experience anxiety symptoms and anhedonia. After a depressive episode or acute mania, it is possible for a person with bipolar disorder to be in a euthymic mood. The mood state may temporarily change due to certain treatments, such as electroconvulsive therapy and others.
Whatever the cause is, it can become difficult to adapt to situations due to inflexibility. This may result in reduced pleasure that can trigger negative emotions. If a person is experiencing euthymia, it does not necessarily mean that the treatment has worked.
Clinical implications of euthymia
By assessing the positive components of euthymia, several clinical implications can be derived. Euthymia does not mean that a mental disorder or acute manifestation is absent. Targeting the treatment is the first implication. To gear the state of euthymia, there are psychotherapeutic treatments.
Well-being therapy (WBT) was used to increase a person's psychological well-being. In many randomized controlled clinical trials, this type of therapy was found to be very effective. This therapy is based on Jahoda’s model of well-being. According to the findings, it is possible to promote optimal human functioning with the help of which one can positively evaluate the following:
- Belief that life is meaningful and purposeful
- Continued development and growth
- Capacity to effectively manage life
- Psychological flexibility
All these modifications are accompanied by enduring benefits. In order to reduce depression from recurring, three randomized controlled trials were conducted and resulted in the above findings.
Another strategy is called acceptance and commitment therapy. By using this therapy, psychological flexibility can be increased. There are many other psychological therapies that are related to positive psychology. Increasing their well-being is their main aim. The only disadvantage is that the clinical reality and over simplistic efforts may clash with each other.
If the concept of euthymia is disregarded, then elevated levels of positive emotions may be inappropriately targeted, which can be dangerous. The complex balance that needs to be maintained between distress and well-being can get disrupted.
Important sources of information can be obtained from the time the comprehensive concept of euthymia is applied to the time the remission is studied and mood disorder is recovered.
People may be kept away from experiencing euthymia due to other disorders, such as bipolar disorder, in which the mood of the person is greatly affected.
In between the periods of state of depression and mania, the person may show fluctuations. Sometimes, an extreme low is experienced, while in other times, an extreme high. It is possible to experience euthymia by regulating the mood.
In order to achieve a state of euthymia in those with mental disorders, medications and therapy can be utilized. The mood tends to become more positive by extracurricular activities, enjoying hobbies, more of meditation, and other physical activities.
Fava G, A, Bech P. The Concept of Euthymia. Psychother Psychosom 2016;85:1-5. doi: 10.1159/000441244
Pavlova, B., et. al. Prevalence of current anxiety disorders in people with bipolar disorder during euthymia: A meta-analysis. Psychological Medicine 2017;47(6), 1107-1115. doi:10.1017/S0033291716003135
Witt SH, et al. Investigation of manic and euthymic episodes identifies state- and trait-specific gene expression and STAB1 as a new candidate gene for bipolar disorder. Transl Psychiatry. 2014;4(8):e426. Published 2014 Aug 19. doi:10.1038/tp.2014.71
Fava GA. Well-being therapy: conceptual and technical issues. Psychother Psychosom. 1999;68(4):171-9. doi: 10.1159/000012329
Stratford H., et. al. Psychological therapy for anxiety in bipolar spectrum disorders: A systematic review,
Clinical Psychology Review. Volume 35, 2015, Pages 19-34, ISSN 0272-7358,