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Cyclothymic Disorder

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Cyclothymic Disorder causes years of long-term, low-grade emotional swings. Symptoms see saw between highs than aren’t super high and lows that aren’t extremely low. It is essentially a mild form of Bipolar Disorder. The lows are similar to those of major depressive episodes. People experience a sad mood and become less interested in their previously enjoyed activities. They can feel hopeless, guilty, and sluggish. However, they never feel enough of these symptoms at once (or feel them strongly enough) for it to become full-blown Major Depressive Episode.

The situation is similar for the highs of Cyclothymic Disorder, too. People go through periods of an energetic, hyper mood. They are talkative, impulsive, and agitated. They bounce from one activity to the next, often impulsively or recklessly. As with the lows of this disorder, the highs never really reach the intensity or number of symptoms it takes to qualify as a hypomanic or manic episode.

Cyclothymic Disorder usually first appears in adolescence or early adulthood. Although it’s not a guarantee, up to half of people with this disorder go on to develop major depression or bipolar disorders. Even if it doesn’t develop into Bipolar Disorder, it can still be a troublesome issue that requires life-long attention.

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Causes and Risk Factors

Genetic ties

Cyclothymic Disorder shares a genetic basis with other mood disorders like Major Depressive Disorder and the Bipolar Disorders. They often cluster together within families. There is also a faint genetic link to substance use disorders.

In the old and young

When Cyclothymic Disorder appears in children, it usually starts around age 6 or 7. It doesn’t need to start early, though. For some people it doesn’t begin until later in adulthood. However, when hypomanic or depressive symptoms do happen in older people, doctors need to make sure they are not due to a biological medical issue first.

Co-occurring disorders

Substance Use Disorders are the most common disorders that appear alongside Cyclothymic Disorder. Children with Cyclothymic Disorder also frequently show symptoms of ADHD.

Suicide risk

As with all disorders that involve depression-type symptoms, people with Cyclothymic Disorder have a higher risk of suicidal behavior. If you having suicidal thoughts, call 911, the National Suicide Prevention Lifeline at 988, or chat online at https://988lifeline.org/chat/.

Diagnosing Cyclothymic Disorder

The criteria

People with Cyclothymic Disorder deal with at least 2 years of chronic, alternating hypomanic symptoms and depressive symptoms. The hypomanic symptoms never escalate to a full hypomanic episode. The same goes for the depressive symptoms. Those never become a full depressive episode, either. These symptoms are present at least half of the time and never subside for more than 2 months.

Additional specifics

Doctors need to rule out other, more likely possibilities before diagnosing someone with Cyclothymic Disorder. These include Schizophrenia and related disorders, Major Depressive Disorder, and Bipolar Disorder, types 1 and 2. The rapid mood swings can also make it difficult to distinguish from Borderline Personality Disorder. Doctors also have to make sure the symptoms are not the result of medications or other drugs. After the initial diagnosis, some people will experience a true major depressive, manic, or hypomanic episode. In these cases, the diagnosis changes to either Major Depressive Disorder or Bipolar Disorder.

Treating Cyclothymic Disorder

Medications

There are no medications that are designed to treat Cyclothymic Disorder. However, medications that doctors use to treat Bipolar Disorder may be helpful.

Lithium is one of the most promising medications in the category of mood stabilizers. Research suggests that Cyclothymic Disorder responds well to lithium, even better than most other mental disorders do. Lithium helps prevent both depressive symptoms and hypomanic symptoms. Other mood stabilizers, such as lamotrigine and valproate, also work well for this.

On the contrary, antidepressants are not a reliable treatment option. Tricyclic antidepressants can help, but the most common antidepressants, SSRIs, do not. In fact, SSRIs can make mood symptoms worse by instigating hypomanic symptoms, increasing mood liability, and increasing the risk of suicide.

Therapy

Cognitive Behavioral Therapy is useful in managing the highs and lows of Cyclothymic Disorder. This therapy focuses on changing negative thinking patterns by learning new emotional skills. It helps mood instability by teaching people adaptable tools to deal with difficult situations.

Interpersonal and social rhythm therapy (IPSRT) is another therapy that can help temper the moodiness of Cyclothymic Disorder. This therapy teaches people to monitor their body’s emotional and social patterns. People learn techniques for taking medications regularly and dealing with unexpected stress.

Managing Cyclothymic Disorder

Listen to your body

Your body has numerous needs and natural rhythms that you should listen to. Possibly the most important one is the daily sleep cycle. Not getting enough sleep or getting poor quality sleep can cause mood instability. Try to give yourself at least 8 hours of time in bed each night. Go to bed at a set time each night even if you don’t feel tired and get up at a regular time, too. You might not feel tired due to hypomanic symptoms, or you might feel overly tired from depressive symptoms.  Setting regular bed times and wake up times helps fight these episodes.

Get some exercise

The other key piece to all this is exercise. Exercise helps use up excess energy that comes from the high episodes of Cyclothymic Disorder. Just 20-30 minutes a day of walking can be enough to help you get to sleep at night. This can also help bring people up from the lows of the depressive episodes in this disorder as well. Study after study has demonstrated that exercise can be just as effective as some antidepressants in these situations.

Stay sober

As with Bipolar Disorder, drugs and alcohol can make mood instability worse. Without treatment, many people look to these substances to help with their mood issues. However, in the long run, that never works and only makes things worse.

Mood monitoring

If you have moods that fluctuate often, monitoring your ups and downs can really help tame the worst episodes. One of the best ways to do this is with a mood journal, daily diary, or mood tracker app on your phone. You can also enlist the help of close friends, family, or your significant other. They might be able to pick out changes in your mood and emotions even before you notice them.

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References
  1. Perugi, G., Hantouche, E., & Vannucchi, G. (2017). Diagnosis and Treatment of Cyclothymia: The “Primacy” of Temperament. Curr. Neuropharmacol., 15(3), 372. doi: 10.2174/1570159X14666160616120157
  2. National Suicide Prevention Lifeline. https://suicidepreventionlifeline.org. Accessed 7/12/22.
  3. Bipolar and related disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed 7/12/22.
  4. Cyclothymia. (2022). NHS. Retrieved from https://www.nhs.uk/conditions/cyclothymia on 7/12/22.
  5. Interpersonal and Social Rhythm Therapy | Home. (2022, July 14). Retrieved from https://www.ipsrt.org on 7/12/22.
  6. Ellen Frank, P. (2005). Two-Year Outcomes for Interpersonal and Social Rhythm Therapy in Individuals With Bipolar I Disorder. Arch. Gen. Psychiatry, 62(9), 996–1004.
  7. Exercise is an all-natural treatment to fight depression – Harvard Health. (2021, February 02). Retrieved from https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-fight-depression