Cyclothymia (cyclothymic disorder)
Filed under: Boomer's Health
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.
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
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
* 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:
* Suicidal thoughts or behavior
* Sleep problems
* Appetite problems
* Loss of interest in daily activities
* Decreased sex drive
* Problems concentrating
* 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.
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.
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
* Your body's biochemical processes, such as changes in brain chemistry
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.
Left untreated, cyclothymia can result in significant emotional problems that affect every area of your life. In addition, cyclothymia significantly increases your risk of developing bipolar disorder.
Preparing for your appointment
If you have signs and symptoms common to cyclothymia, call your doctor. After your initial appointment, your doctor may refer you to a mental health provider who can help make a firm diagnosis and create the right treatment plan for you.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
* Write down any symptoms you've been experiencing, and for how long.
* Write down all of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications you're taking, including over-the-counter medications, vitamins and supplements.
* Ask a trusted family member or friend to be present for your appointment, if possible. It will be very helpful to your doctor to ask someone close to you about the signs and symptoms they may have noticed. In addition, someone who accompanies you may remember something that you missed or forgot.
* Write down questions to ask your doctor.
Questions to ask your doctor at your initial appointment include:
* What do you believe is causing my symptoms?
* Are there any other possible causes?
* How will you determine my diagnosis?
* Should I see a mental health specialist?
Questions to ask if you are referred to a mental health provider include:
* What is my diagnosis?
* What treatments are likely to be helpful in my case?
* How much do you expect my symptoms to improve with treatment?
* Will I need to be treated for the rest of my life?
* What lifestyle changes can help me manage my symptoms?
* How often should I be seen for follow-up visits?
* Am I at increased risk of other mental health problems?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared in advance, don't hesitate to ask for more information at any time that you don't understand something.
What to expect from your doctor
A doctor or mental health provider who sees you for a possible mood disorder may ask:
* How would you describe your symptoms?
* How have the people close to you described your symptoms?
* When did you or your loved ones first notice these symptoms?
* Have your symptoms been getting better or worse over time?
* If you have intense high and low periods, how long do these periods generally last?
* Do you also have periods where your mood feels relatively stable?
* How would you or your loved ones describe your mental and emotional state during high versus low periods?
* How would you or your loved ones say your choices and behaviors change during high versus low periods?
* Do your physical needs change during high versus low periods, such as your need for sleep, food or sex?
* How are these cycles affecting your life, including work, school and relationships?
* What prompted you to seek treatment?
* Have any of your close relatives had similar symptoms?
* Have you been diagnosed with any medical conditions?
* Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?
* Have you ever thought about harming yourself or others?
* Do you drink alcohol or use illegal drugs? If so, how often?
Tests and diagnosis
To help pinpoint a diagnosis for your symptoms, you'll likely have several exams and tests. Your doctor or other health care provider must determine if you have cyclothymia, bipolar disorder, depression or another condition that may be causing your symptoms.
These exams and tests generally include:
* Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
* Laboratory tests. These may include a complete blood count (CBC) as well as thyroid tests and other blood tests. You may also have a urinalysis or tests for drug and alcohol use.
* Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. You may also fill out psychological self-assessments and questionnaires. You may be asked about substance or alcohol abuse. And with your permission, family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression.
Diagnostic criteria for cyclothymic disorder
To be diagnosed with cyclothymic disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Diagnostic criteria for cyclothymia include:
* You've had numerous periods of elevated mood (hypomania) and numerous periods of depressive symptoms for at least two years
* Your periods of stable moods usually last less than two months
* You don't have manic episodes, major depression or schizoaffective disorder
* Your symptoms aren't caused by substance abuse or a medical condition
* Your symptoms significantly affect you socially, at work, at school or in other important functions
Treatments and drugs
Cyclothymia is a long-term condition that requires lifelong treatment, even during periods when you feel better. Cyclothymia treatment is usually guided by a mental health provider skilled in treating the condition. Because cyclothymia has a high risk of developing into bipolar disorder, it's important to get effective and appropriate treatment.
Treatment is also vital for reducing the frequency and severity of hypomanic and depressive episodes and allowing you to live a more balanced and enjoyable life. Maintenance treatment — continued treatment during periods of remission — is also important. If you skip maintenance treatment, you may be at higher risk of having a relapse of cyclothymia symptoms or having minor episodes turn into larger problems.
If you have problems with alcohol or substance abuse, you must get treatment for those, too, since they can worsen cyclothymia symptoms.
The main treatments for cyclothymic disorder are medications and psychotherapy.
Medications may help control cyclothymia symptoms and prevent episodes of hypomania and depression. Medications commonly used to treat cyclothymia include:
* Mood stabilizers. Mood stabilizers are the most commonly prescribed medications for cyclothymic disorder. These medications help regulate and stabilize mood so that you don't swing between depression and hypomania. Lithium (Eskalith, Lithobid) has been widely used as a mood stabilizer and is generally the first line of treatment for hypomanic episodes. Your doctor may recommend that you take mood stabilizers for the rest of your life to prevent and treat hypomanic episodes.
* Anti-seizure medications. The medications, also known as anticonvulsants, are used to prevent mood swings. They include valproic acid (Depakene), divalproex sodium (Depakote) and lamotrigine (Lamictal).
* Other medications. Certain atypical antipsychotic medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), may help people who don't benefit from anti-seizure medications. Anti-anxiety medications, such as benzodiazepines, may help improve sleep. In addition, one medication, quetiapine (Seroquel), has been approved by the Food and Drug Administration to treat both the manic and depressive episodes of bipolar disorder and may also be helpful for cyclothymic disorder.
* Antidepressants. Use of antidepressants in cyclothymic disorder is typically not recommended, unless they're combined with a mood stabilizer. As with bipolar disorder, taking antidepressants alone can trigger potentially dangerous manic episodes. Before taking antidepressants, carefully weigh the pros and cons with your doctor.
If one medication doesn't work well for you, there are many others to consider. Keep trying until you find one that works well for you. Your doctor may advise combining certain medications for maximum effect. It can take several weeks after first starting a medication to notice an improvement in your cyclothymia symptoms.
Be aware that all medications have side effects and possible health risks. Certain antipsychotic medications, for instance, may increase the risk of diabetes, obesity and high blood pressure. If you take these medications, talk to your doctor about being monitored for health problems. Also, mood-stabilizing medications may harm a developing fetus or nursing infant. Women with cyclothymic disorder who want to become pregnant or do become pregnant must fully explore with their health care providers the benefits and risks of medications.
Psychotherapy is another vital part of cyclothymia treatment. Psychotherapy, also called counseling or talk therapy, can help you understand what cyclothymia is and how it's treated.
Types of therapy that may help cyclothymia include:
* Cognitive behavioral therapy. This is a common form of individual therapy for cyclothymia. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. In addition, you can explore what may trigger your hypomanic or depressive episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
* Family therapy. Family therapy involves you and your family members. Family therapy can help identify and reduce stressors within your family that may contribute to unhealthy behavior patterns. Family therapy can also help your family improve its communication style and problem-solving skills and resolve conflicts. And it may help your family — whether parents, siblings or partners — better understand your condition and why you think and behave the way you do.
* Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.
* Social rhythm therapy. This type of therapy helps you manage your daily routines, including your sleep schedule, and improve your relationships so that interpersonal problems don't disrupt your routines.
Lifestyle and home remedies
Cyclothymia generally isn't an illness that you can treat on your own. But you can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these lifestyle and self-care steps for cyclothymia:
* Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, cyclothymia signs and symptoms are likely to come back.
* Pay attention to warning signs. You and your caregivers may have identified a pattern to your cyclothymia episodes and what triggers them. Call your doctor if you feel you're facing an episode. Involve family members or friends in watching for warning signs. Addressing symptoms early on can prevent episodes from becoming full-blown.
* Avoid drugs and alcohol. Alcohol and illegal drugs may trigger mood changes.
* Check first before taking other medications. Call the doctor who's treating you for cyclothymic disorder before you take medications prescribed by another doctor. Sometimes other medications trigger episodes of bipolar disorder or may interfere with medications you're already taking.
* Keep a record. Track your moods, daily routines and significant life events. These records may help you and your mental health provider understand the effect of treatments and identify thinking patterns and behaviors associated with cyclothymic symptoms.
Coping and support
Coping with cyclothymia can be difficult. Medications can have unwanted side effects, and you may feel angry or resentful about having a serious condition that requires lifelong treatment. During periods when you feel better, or during hypomanic episodes, you may be tempted to stop your cyclothymia treatment. Here are some ways to cope with cyclothymic disorder:
* Learn about cyclothymia. Learning about your condition and its possible complications can empower you and motivate you to stick to your treatment plan.
* Join a support group. Support groups for people with cyclothymia or even bipolar disorder can help you reach out to others facing similar challenges.
* Stay focused on your goals. Recovery from cyclothymic disorder can take time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships, work problems, financial woes or other issues.
* Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
* Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.
There's no sure way to prevent cyclothymia. However, treatment at the earliest indication of a mental health disorder can help prevent cyclothymia from worsening. Long-term preventive treatment also can help prevent minor episodes from becoming full-blown episodes of mania or depression.