Cyclothymia is a mild form of bipolar disorder, characterized by episodes of hypomania (elevated mood and euphoria) and moderate depression.
Cyclothymia, a mild form of bipolar disorder, is characterized by mood swings from mild or moderate depression to hypomania. Hypomania involves periods of elevated mood, euphoria, and excitement but does not disconnect a person from reality.
A person with cyclothymia experiences symptoms of hypomania but no full-blown manic episodes. Hypomania may feel good to the person who experiences it and may lead to enhanced functioning and productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that a problem exists. Without proper treatment, however, hypomania can become severe mania or can turn into depression.
For cyclothymic symptoms to be diagnosed, hypomanic symptoms and depressive symptoms must be present alternately for at least two years. The risk of bipolar disorder developing in people with cyclothymia is about 33 percent. While this is 33 times greater than that for the general population, this rate of risk is still too low to justify viewing cyclothymia as merely an early manifestation of bipolar type I disorder.
For at least two years (one year for children and adolescents), the individual displays periods of hypomanic symptoms and periods of depressive symptoms that do not meet criteria for a major depressive episode.
Hypomanic symptoms are similar to manic symptoms but are much shorter in duration, lasting a minimum of four days.
Signs and symptoms of mania (or a manic episode), which are similar to those of cyclothymia (or a hypomanic episode), include:
A hypomanic episode is diagnosed if elevated mood occurs alongside three or more other symptoms most of the day, nearly every day, for four days or longer. If the mood is irritable, four additional symptoms must be present. A manic episode is diagnosed if symptoms continue for one week or longer.
The depressed phase of both types of bipolar disorder (I & II) involves very serious symptoms of major depression:
In people with bipolar disorder II, hypomanic and depressive episodes involve similar symptoms that are less intense.
An individual may be diagnosed as cyclothymic if:
The cause of cyclothymic disorder is unknown. Although mood swings are irregular and abrupt, the severity of the mood swings is far less extreme than in people with bipolar disorder (manic-depressive illness). Unlike bipolar disorder, periods of hypomania do not turn into mania, in which the person may lose control over his or her behavior and go on spending binges, engage in risky sexual behavior, or drug use and lose touch with reality.
Hypomanic periods are energizing and can result in productivity for some people, while for others these periods can cause impulsive and callous behavior, which can damage relationships. Because hypomania feels good, people with cyclothymia may not seek treatment.
To understand the causes of cyclothymia, it may be useful to explore the causes of bipolar disorder.
Most scientists now agree that there is no single cause of bipolar—rather, many factors act together to produce the illness.
Because bipolar disorder tends to run in families, researchers search for specific genes that may increase an individual's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop it, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop it than is another non-twin sibling.
Bipolar disorder, like other mental illnesses, does not occur because of a single gene. It appears likely that many different genes act together, and in combination with other factors of the individual or the individual's environment. Finding these genes, each of which contributes only a small amount toward the likelihood of bipolar disorder, has been extremely difficult. But scientists expect that advanced research tools currently in use will lead to more effective treatments. Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses.
It is informative to explore treatments for bipolar disorder in learning about treatments for cyclothymia.
Treatments for Bipolar Disorder
Most people with bipolar disorder—even the most severe forms—can achieve substantial stabilization of their symptoms with proper treatment. Because this is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and treatment is optimal for managing bipolar disorder over time.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is sporadic. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with a professional and communicating openly about any concerns and options can make a difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.
Medications for the disorder are prescribed by psychiatrists. While primary care physicians who do not specialize in psychiatry also may prescribe medications, it is preferred that people with bipolar disorder see a psychiatrist for treatment.
"Mood stabilizers" usually are prescribed to help control bipolar disorder. Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time. Other medications are added as required, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.
Lithium, approved for the treatment of acute mania in 1970 by the U.S. Food and Drug Administration (FDA), has been an effective mood-stabilizing medication for many people with bipolar disorder.
Anticonvulsant medications, particularly valproate and carbamazepine, have been used as alternatives to lithium in many cases. Newer anticonvulsant medications, including lamotrigine, gabapentin and topiramate, are being studied to determine their efficacy as mood stabilizers in bipolar disorder. Some research suggests that different combinations of lithium and anticonvulsants may be helpful.
Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine are helpful as well. Researchers are studying the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20. Therefore, young female patients taking valproate should be monitored carefully by a physician.
Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant. The benefits and risks of all available options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are currently being studied.
Changes to the treatment plan may be needed at various times. A psychiatrist should guide any changes in type or dose of medication.
Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is crucial because certain medications and supplements mixed together may cause adverse reactions. To reduce the chance of relapse, it is wise to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.
As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or "talk" therapy)—can provide support, education, and guidance to those struggling with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and sharper functioning in several areas. A licensed psychologist, social worker, or counselor typically provides these therapies, often working with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. Certain types of psychotherapy or other interventions, in combination with medication, can offer additional benefit. These include cognitive-behavioral therapy, interpersonal and social rhythm therapy, family therapy and psychoeducation.