Cyclothymia

Cyclothymia, also called cyclothymic disorder is a rare disorder of mood in which individuals experience periods of emotional highs and lows, not to be confused with bipolar I or II disorder in which the highs are higher and the lows lower.

These extreme periods can have a stable period between them. Cyclothymia is milder than bipolar disorder but can significantly impact normal functioning and may lead to bipolar I or II disorder as well.

The cause is unknown and treatment includes a combination of psychotherapy, medications and close, long lasting cooperation with doctor.

Cyclothymia causes a roller-coaster of mood with the ups resembling hypomanic symptoms like heightened mood and the downs resembling mild or moderate depressive symptoms.

Though similar to bipolar I or II disorder, cyclothymia symptoms are less intense. Normal daily activities may be affected by cyclothymia as you have consistent mood swings which are out of your control.

Hypomanic symptoms

• A feeling of intense happiness or well-being (euphoria)
• Abnormally high optimism
• Exaggerated self-esteem
• Excessive talking, not normally seen
• Impaired judgment leading to risky behavior or unwise choices
• Rapid thoughts
• Irritable or agitated behavior
• Over exertion
• Increased social, sexual or work related drive
• Reduced sleep
• Easy distractions
• Concentration problems

Depressive symptoms

• Feeling down, hopeless or empty
• Tendency to cry for no apparent reason
• Irritability, more common in children and teenagers
• Inability to gain pleasure from the activities which used to be enjoyable
• Weight loss or gain
• Feeling worthless or guilty
• Sleep problems
• Restlessness
• Tiredness
• Concentration problems
• Suicidal thoughts or ideation

When to see a doctor?

Ask for immediate medical attention if you or your loved one has any symptoms of cyclothymia. Mental illnesses are more likely to be kept under the veil possibly due to associated stigma.

Like any other disorder, mental illnesses including cyclothymia are a normal diagnosis. With proper diagnosis, treatment and support, these can have better outcomes.

If you are having some suicidal thoughts, don’t think more, just:

• Call 911 or your local emergency services number, or go to a hospital emergency department.
• Call a local crisis center or suicide hotline number in the United States,
• Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor. (Use that same number and press "1" to reach the Veterans Crisis Line)

If calling is not possible, immediately seek help from your doctor, mental health provider, family member, friend or someone in your faith community.

The exact cause of cyclothymia is unknown. It is thought to occur from a combination of following:

• Genes: Studies indicate heredity could be a reason behind cyclothymia.
• Biochemical changes in brain.
• Life events, such as traumatic experiences or prolonged periods of stress

If you are experiencing signs and symptoms of cyclothymia, your doctor may refer you to a mental health provider for a diagnosis.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your mental health provide

Some typical questions can be:

• What could be possible causes of my symptoms?
• What are my treatment options?
• To what extent will my symptoms improve?
• How long will the treatment last?
• Is it possible to manage the symptoms with lifestyle changes?
• How often do I need the follow-up visits?
• Am I likely to develop other mental health problems?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your mental health provider might ask you typical questions like:

• How do you feel?
• What do people close to you say about your symptoms?
• When did the symptoms start appearing?
• Have you noticed any changes in your symptoms over time?
• Can you tell me the duration of a high and a low period?
• Do you experience any stable period between the highs and the lows?
• Can you describe your feelings during a high and a low period?
• What do your closed ones say about this?
• Have you noticed changes in your need for sleep, food or sex during the highs and lows?
• How have these symptoms affected your work, school and relationships?
• Do you have a family history of similar condition?
• Did you receive any treatment for other psychiatric illnesses or mental disorders in the past? If yes, what type of therapy helped you the most?
• Has your mind ever been occupied with feelings self-harm?
• Do you do drugs?
• How often do you drink alcohol, if any?

The signs of cyclothymia are similar to those produced by a variety of other mental disorders like bipolar I or II disorder or depression. Your mental health provider can order following tests to differentiate cyclothymia from other conditions:

Physical exam

Physical exam and lab tests are simple tests used to detect probable causes for your symptoms.

Psychological evaluation

Your mental health provider can evaluate your thoughts, feelings and behavior patterns after talking to you. Also, s/he may ask you to fill a form containing several related questions and also ask your family members or close friends about your condition.

Mood recording

A daily record of moods, sleep and behavior patterns can help your mental health provider have a closer look upon your situation which in turn helps in better diagnosis and better treatment approach.

Diagnostic criteria

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to be diagnosed with cyclothymia, you should fulfill the following criteria:

• Periods of 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 all the aspects of your life.
• 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 for cyclothymia stretches over your lifetime. Do not panic, they will help you live a quality life. The treatments are aimed at:

• Avoiding progression of condition to bipolar I or II disorder.
• Reducing the frequency and severity of your symptoms.
• Preventing the condition from coming back.
• Treating alcohol or substance abuse.

The treatments for cyclothymia include

Medications

There are no FDA approved medications to treat cyclothymia. However, bipolar disorder medications may be prescribed to control symptoms and prevent periods of highs and lows.

Psychotherapy

Psychotherapy is an indispensable aspect of cyclothymia treatment. It is also called psychological counseling or talk therapy.

Cognitive behavioral therapy

A commonly employed cyclothymia treatment, this approach uses a simple idea of replacing your negative thoughts with the positive ones. It teaches you appropriate coping strategies and stress management skills.

Interpersonal and social rhythm therapy (IPSRT)

The idea behind this approach is to set standard routines for daily activities including sleep, exercise, and mealtimes, and following them on a daily basis.

Talk to you mental health provider if other approaches work for you.

Unfortunately, preventing cyclothymia is not possible. But early treatment may help to avoid complications or progression of condition to full-blown hypomania, mania or major depression.

Here are some lifestyle modifications used for cyclothymia that might help you:

• Don’t skip or discontinue medications.

• Identify the triggers and work on to keep them from harming you.

• Say No to alcohol and drugs: They can trigger symptoms of cyclothymia. Ask your doctor to find an appropriate quitting strategy.

• Don’t pop a pill from your shelf without consulting your doctor: Some other medications can trigger cyclothymia symptoms or may affect action of cyclothymia medications.

• Keep a record of your daily activities, moods and other life events.

• Exercise. Low intensity can may help to stabilize your mood.

• Sleep well: Get enough sleep. If you cannot, talk to your doctor. Remember that sleep is an important factor that regulates your mood.

Here are some coping strategies that might help you 

• Acquire enough knowledge on cyclothymia and stay updated: An extensive knowledge of your condition can help make you aware of the complications, the fear of which can motivate you to follow therapy. You may also share your knowledge with your family and friends.

• Join a support group: You may join a support group in your community or online, if available.

• Don’t lose sight of your treatment goal: Don’t get disheartened by the roadblocks that come your way. Lift yourself and move ahead towards your goal.

• Develop a hobby: Use your energy in some creative and satisfying activities.

• Manage stress: Learn yoga or tai chi to keep manage stress.

There are several risks and complications associated with cyclothymia.

There are few epidemiological data on cyclothymia. It can be due to difficulties in diagnosing the condition or misdiagnosis due to other conditions having similar clinical presentations, such as depression and bipolar disorder.

Data show that cyclothymia is more likely to start during the teenage years or young adulthood.

It exhibits no gender discrimination and the risk is almost same in both male and female.

If not treated timely, it can progress to bipolar I or II disorder and increases risk of developing anxiety disorder.