Cyclothymia (cyclothymic disorder)

Cyclothymia (si-kloh-THIGH-me-uh), also called cyclothymic disorder, is a mild form of bipolar disorder. Like bipolar disorder, cyclothymia is a chronic mood disorder that causes emotional ups and downs.

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

Compared with bipolar disorder, the highs and lows of cyclothymia are less extreme. Still, it's critical to seek help managing these symptoms because they increase your risk of bipolar disorder. Treatment options for cyclothymia include psychotherapy, medications, and — most important — close, ongoing follow-up with your doctor.

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Symptoms

Cyclothymia symptoms include an alternating pattern of emotional highs and lows. The highs of cyclothymia are characterized hypomanic symptoms, which resemble those of mania, but are less severe. The lows consist of mild or moderate depressive symptoms.

Cyclothymia symptoms are generally similar to those of bipolar 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 — and you can't just will yourself to live life on an even keel.


Hypomanic phase of cyclothymic disorder


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Signs and symptoms of hypomanic episodes of cyclothymia may include:
  • Unusually good mood or cheerfulness (euphoria)
  • Extreme optimism
  • Inflated self-esteem
  • Poor judgment
  • Rapid speech
  • Racing thoughts
  • Aggressive or hostile behavior
  • Being inconsiderate of others
  • Agitation
  • Increased physical activity
  • Risky behavior
  • Spending sprees
  • Increased drive to perform or achieve goals
  • Increased sexual drive
  • Decreased need for sleep
  • Tendency to be easily distracted
  • Inability to concentrate
Depressive phase of cyclothymic disorder
Signs and symptoms of depressive episodes of cyclothymia may include:
  • Sadness
  • Hopelessness
  • Suicidal thoughts or behavior
  • Anxiety
  • Guilt
  • Sleep problems
  • Appetite problems
  • Fatigue
  • Loss of interest in daily activities
  • Decreased sex drive
  • Problems concentrating
  • Irritability
  • Chronic pain without a known cause
When to see a doctor
If you have any symptoms of cyclothymia, seek medical help as soon as possible. Cyclothymic disorder generally doesn't get better on its own. If you're not sure where to start with treatment, see your primary health care provider. He or she may refer you to a mental health provider with experience in cyclothymia or bipolar disorder.

If you're reluctant to seek treatment, try to work up the courage to confide in someone, whether it's a friend or loved one, a health care professional, a faith leader, or someone else you trust. He or she can help you take the first steps to successful treatment.

If you have a loved one you think may have symptoms of cyclothymia, have an open and honest discussion about your concerns. You can't force someone to seek professional help, but you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider.

Suicidal thoughts
If you're considering suicide right now, call 911 or your local emergency services number. If you just can't make that call, pick up the phone and reach out to someone else — immediately:
  • Contact a family member or friend.
  • Contact a doctor, mental health provider or other health care professional.
  • Contact a minister, spiritual leader or someone in your faith community.
  • Go to your local hospital emergency room.
  • Call a crisis center or hot line.
If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help.

Diagnostic Criteria

Diagnostic criteria are as follows:
- Symptoms present for at least 2 years, the patient has had periods of hypomanic symptoms and periods of low mood that don't fulfill the criteria for Major Depressive Disorder.
- The longest period the patient has been free of mood swings is 2 months.
- During the first 2 years of this disorder, the patient has not fulfilled criteria for Manic, Mixed, or Major Depressive Episode.
- Schizoaffective disorder doesn't explain the disorder better, and it isn't superimposed on Schizophrenia, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
- The symptoms are not directly caused by a general medical condition or the use of any substances, including prescription medications.
- These symptoms cause the patient clinically important distress or impair work, social or personal functioning.

Causes

It's not known specifically what causes cyclothymia. As with many mental disorders, research shows that it may result from a combination of:
  • Heredity — cyclothymia tends to run in families. One is 2-3 times more likely to have the disorder if someone in the immediate family has it or if an identical twin has it. In a study by Bertelsen, Harvard, and Huage (1977), if an identical twin had depression, 59% of the identical twins had it also. Heritability for women ranges from 36-44%; for men, 18-24%.
  • Your body's biochemical processes, such as changes in brain chemistry. Serotonin: Serotonin regulates other hormones like norepinephrine and dopamine, so when serotonin is low, the other chemicals may fluctuate, causing irritability, impulsivity and mood irregularities such as dysthymia and depression. Cortisol: Depressed individuals can have high cortisol levels. Cortisol is a stress hormone, and mood disorders often occur during stressful points in one’s life. Elevated stress hormones can affect functioning of the hippocampus, an important centre for memory and cognitive processes. Overproducing cortisol can also impair the brain’s ability to regenerate neurons in the hippocampus.
  • Environment and stressful events, as perceived by the individual. Job loss, relationship failure, identity change, natural disaster, learned helplessness and hopelessness, extreme feelings, negative thinking patterns.
  • Parenting styles.
Risk factors

Cyclothymia is thought to be relatively rare. But true estimates are hard to pin down because people may be undiagnosed or misdiagnosed as having other mood disorders, such as depression.
Cyclothymia typically starts during adolescence or young adulthood. The condition affects about the same number of men and women.

Tests & diagnosis
The person's own description of the behavior usually leads to diagnosis of the disorder.

Prognosis

This disorder usually has an insidious onset in adolescence or early adult life. It often develops with prolonged periods of cyclical, often unpredictable mood changes (e.g., the person may be regarded as temperamental, moody, unpredictable, inconsistent, or unreliable). This disorder usually has a chronic course, and has a 15%-50% risk that the person will eventually develop Bipolar I or II Disorder.

Most people do not need long-term therapy.

Treatment
The most important first step in the treatment of this disorder is to prevent alcohol or illicit drug abuse. Medication often is ineffective when the individual is still abusing alcohol or illicit drugs.

A combination of antimanic drugs, antidepressants, or psychotherapy are used to treat cyclothymic disorder. Medications used to treat this condition are called mood stabilizers.

  • Lithium. Lithium has been used for years in patients with bipolar disorder, and it may also help patients with cyclothymic disorder.
  • Antiseizure drugs. Valproic acid (Valproate), carbamazepine (Tegretol), oxcarbazepine (Trileptal), and lamotrigine (Lamictal) are the most established antiseizure drugs. Other antiseizure drugs used for bipolar disorders include gabapentin (Neurontin), zonisamide (Zonegran), and topiramate (Topamax).
  • Antipsychotics.
  • Antidepressants are not recommended because they can trigger a manic episode.
It has been repeatedly demonstrated that physical exercise can help with mood regulation and emotional stability

Patients may not respond to medications as strongly as do patients with bipolar disorder.


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