Cyclothymic Disorder

Individuals with cyclothymic disorder experience periods of hypomanic symptoms and periods of depressive symptoms. They often experience periods of stability where they are symptom-free, but these periods may last less than two months.

Hypomanic symptoms

To not qualify as bipolar II disorder,² the hypomanic episodes must be under four days or occur alongside depression that lasts less than two weeks. In a hypomanic state, individuals may experience:

• Increased energy and activity levels
• Euphoric mood or exaggerated optimism
• Decreased need for sleep without tiredness
• Increased talkativeness
• Distractibility or difficulty concentrating
• Impulsive or risky behavior, such as reckless driving or unwise financial decisions
• Racing thoughts
• Inflated self-esteem 

Hypomanic symptoms are not as severe as those seen in a full manic episode and don't significantly interfere with the person's work, school, or social relationships. While some people may function well with hypomanic symptoms, others may have functional difficulties, and hypomania is still a mental health challenge, not a benefit. 

Depressive symptoms

During periods of depression lasting under two weeks at a time, individuals may display:

• Persistent sadness, hopelessness, or emptiness
• Lack of energy or fatigue
• Trouble concentrating, remembering, or making decisions
• Changes in sleep patterns—sleeping too much or insomnia
• Changes in appetite or weight—overeating or not eating enough
• Unexplained physical problems, such as headaches or back pain
• Recurrent thoughts of death or suicide
• Irritability 
• Loss of interest in previously enjoyed activities 

While these depressive symptoms can be distressing, they do not meet the full criteria for a major depressive episode.

Chronic nature of cyclothymic disorder

One of the defining features of cyclothymic disorder is the chronic, persistent nature of mood disturbances. Individuals with this form of bipolar disorder experience symptoms for at least two years (one year in children and adolescents), with no more than two symptom-free months.

As with any mental health disorder, the exact manifestation of symptoms can vary significantly between individuals. Individuals experiencing these symptoms can seek professional help for an accurate diagnosis and appropriate treatment.

The exact cause of cyclothymic disorder is not fully understood, like with other mental health conditions. However, a combination of several factors may be involved, including the following. 

Genetic factors

Having a first-degree relative, such as a parent or sibling, with bipolar disorder or a depressive disorder increases the risk of developing cyclothymic disorder, suggesting a genetic component.

Biochemical factors

As with major depressive disorder, bipolar I, and bipolar II, research suggests that alterations in the structure or function of the brain may play a role in the development of cyclothymic disorder. However, more research is needed in this area. In addition, an imbalance in the brain chemicals that regulate mood, including serotonin and dopamine, may contribute to cyclothymic disorder.

Environmental factors

High stress levels may incite the onset of cyclothymic disorder or exacerbate its symptoms. No identified specific risk factors may universally apply to individuals with cyclothymic disorder. However, individuals may have personal inciting events, particular situations, or stressors that exacerbate their symptoms.

While these factors can increase the risk of developing cyclothymic disorder, they do not guarantee the onset of the disorder. Some people with these risk factors never develop the condition, and conversely, some people with none of these risk factors do. The complexity of the human brain and individual experiences create various outcomes.

Treatment for cyclothymic disorder primarily aims to manage and reduce symptoms, prevent the progression to bipolar I disorder or bipolar II disorder, and improve the individual's ability to function and enjoy a high quality of life. Treatment plans are typically comprehensive, combining medication, psychotherapy,³ and lifestyle adjustments.

Medication

Medication can also play a crucial role in managing the symptoms of cyclothymic disorder. There are no specific medications approved by the FDA for this disorder, but doctors may prescribe medications used to treat bipolar disorder.

• Mood stabilizers: Mood stabilizers are commonly used to control the mood swings associated with cyclothymic disorder.
• Antidepressants: These medications may help patients manage depressive symptoms, though they must be used with care as they can sometimes cause a hypomanic episode.
• Antipsychotics: Some atypical antipsychotics may also be used, particularly if other treatments are ineffective.

As with any medication regimen, individuals must take their medications as prescribed, communicate any side effects to their healthcare provider, and not stop without professional guidance. Consult a doctor before starting or changing a medication for any condition. 

Other treatment options

In addition to therapy and medication, several other treatment options can help individuals manage symptoms of cyclothymic disorder: 

• Electroconvulsive therapy (ECT): ECT may be considered in severe cases or when other treatments are ineffective. This procedure involves sending small electric currents through the brain to trigger a brief seizure, which can alter brain chemistry and relieve symptoms.
• Transcranial magnetic stimulation (TMS): This noninvasive procedure uses a magnet to stimulate nerve cells in the brain, which can improve symptoms of depression.

Self-care

Self-care practices are a vital part of managing cyclothymic disorder. People with cyclothymia may benefit from the following strategies:  

• Regular exercise: Physical activity may reduce depression and anxiety symptoms, improve sleep, and boost mood.
• Healthy diet: A balanced diet can significantly impact mood and energy levels.
• Regular sleep: Maintaining a regular sleep schedule may help manage mood swings.
• Stress management: Techniques like yoga, meditation, deep-breathing exercises, or mindfulness can help individuals manage stress levels.
• Substance avoidance: Substances can exacerbate mood swings and negatively affect medications.

Treatment plans can be tailored to an individual's unique needs and symptoms, with regular adjustments based on the individual's response to treatment. Individuals with cyclothymic disorder can work closely with their healthcare provider to find the most effective treatment plan.

One resource for individuals living with cyclothymic disorder is professional therapy, which can provide them with the tools to manage their symptoms and improve their overall quality of life. Online therapy platforms like BetterHelp make connecting with a licensed therapist from the comfort of one's home easier. The platform offers professionals specializing in mood disorders and can help clients navigate cyclothymic disorder.

Apart from therapy, several other resources can be helpful, including the following: 

• National Institute of Mental Health (NIMH): As part of the US Department of Health and Human Services, the NIMH provides a wealth of information on all mental health disorders, including cyclothymic disorders.
• National Alliance on Mental Illness (NAMI): NAMI is a grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illnesses. They offer education programs, advocacy, and local support groups.
• Depression and Bipolar Support Alliance (DBSA): DBSA provides information, tools, and peer support groups for individuals with mood disorders, including cyclothymic disorder.

Note that these resources are intended to complement, not replace, professional medical advice. Consult a healthcare provider for personalized medical advice.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

Emerging research continues to explore the complexities of cyclothymic disorder and potential advancements in its treatment.

A study published in the Journal of Affective Disorders in 2017 examined the effectiveness of lamotrigine, a mood stabilizer, in treating cyclothymic disorder. The research involved a six-month, open-label trial with 52 patients. The results suggested that lamotrigine may effectively treat both depressive and hypomanic symptoms in patients with cyclothymic disorder, contributing to a better understanding of pharmacological treatment options for this condition.

Another area of ongoing research focuses on the cognitive aspects of cyclothymic disorder. A book chapter from The Treatment of Bipolar Disorder: Integrative Clinical Strategies and Future Directions discusses the cognitive styles associated with the condition. The authors argue that individuals with cyclothymic disorder may have a unique cognitive style that can amplify mood reactivity to emotional stimuli, thus exacerbating their mood instability. 

Understanding these cognitive aspects could pave the way for more targeted cognitive-behavioral therapy approaches tailored to the specific needs of individuals with cyclothymic disorder.

0.4% to 1% of the population has cyclothymic disorder

Cyclothymic disorder is a rare mental health condition, affecting 0.4% to 1% of the world population. Treatment for this disorder is similar to treatment for bipolar disorder. ¹

¹National Library of Medicine

Below are more key statistics on cyclothymic disorder:

• Cyclothymic disorder often begins in adolescence or early adulthood, a critical period for the onset of many mental health conditions.
• There is an equal prevalence of cyclothymic disorder in men and women, unlike other mood disorders with gender bias.
• Although the chronic nature of cyclothymic disorder can pose treatment challenges, some individuals respond positively to a combination of medication and therapy, improving their symptoms and quality of life.