Do I have cyclothymia? Symptoms, diagnosis, and treatment

Cyclothymic disorder is a mild form of bipolar disorder II, characterized by emotional ups and downs. With cyclothymic disorder, an individual might feel great one week, and then low or down the next. 

Without treatment, the time in between these mood swings might feel fine—but when their symptoms flare, they might not always be able to handle their emotions or balance their responsibilities, relationships, and more. 

Though these emotional ups and downs aren’t usually as intense as bipolar disorder II, the unpredictability of cyclothymic disorder can still significantly impact someone’s life. It’s important to seek counseling and/or psychiatric care to help manage these symptoms. 

What Are the Symptoms of Cyclothymic Disorder?

Because people with cyclothymic disorder experience both hypomanic and depressive symptoms, it’s helpful to separate the two. The hypomanic symptoms of cyclothymic disorder include:

• Exaggerated feeling of happiness and euphoria
• Overzealous optimism
• Exaggerated self-esteem
• More talkative than normal
• Lack of good judgment that leads to risky behavior or irresponsible choices
• Racing thoughts
• Irritability
• Hyperactivity
• Heightened desire to perform or meet goals
• Lessened desire for sleep
• Easily distracted
• Difficulty concentrating

In comparison, the depressive symptoms of cyclothymic disorder might include:

• Feelings of sadness or hopelessness
• Feelings of emptiness
• Lack of interest or enjoyment in once beloved activities
• Irritability (especially in children and adolescents)
• Feeling worthless or guilty
• Changes in weight
• Difficulty sleeping
• Difficulty concentrating
• Feelings of restlessness
• Suicidal thoughts or ideation

The classic example of cyclothymic disorder is someone displaying symptoms of depression, such as feeling low, sad, irritable, and fatigued. But then suddenly, they’re fine—and then shortly afterward, they may show symptoms of hypomania, feeling and looking cheerful, full of energy, and more productive than usual.

How Is Cyclothymic Disorder Different from Bipolar Disorder?

Cyclothymic disorder is a form of bipolar II that is considered less severe consisting of mild depression and hypomania fluctuations. More specifically, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), an individual must present the following to be diagnosed with cyclothymic disorder:

• The individual has experienced multiple periods of elevated mood, or hypomanic symptoms, and periods of depressive symptoms for at least two years (one year for children and teens)—these highs and lows occur at least half the time.
• Periods of stability typically last under two months.
• The individual’s symptoms significantly affect their work, school, social life, or other important areas.
• The above symptoms don’t meet the criteria for bipolar I or II, major depression, or another mental disorder.
• The symptoms are not caused by substance use or a medical condition. 

Cyclothymic onset of age is generally around early adulthood and late adolescence.

What Triggers Cyclothymic Disorder?

Cyclothymic disorder can be triggered by several factors, including: 

• Stress (whether it is environmental or interpersonal stress) 
• Poor sleep routine
• Chronic mental or physical health conditions
• Trauma
• Anxiety
• Depression
• Hormonal imbalances 
• And more

As with the development of other disorders and conditions, experts tend to agree that there’s a unique blend of internal and external factors (genetics and environment) that influence whether someone develops cyclothymia or another condition.

What Causes the Development of Cyclothymic Disorder?

The majority of mental health professionals and researchers agree that there is no single cause of cyclothymic disorder; instead, many factors play a part in development. That said, it is common for individuals with cyclothymic disorder to have biological relatives with major depressive disorder or bipolar I or II, or another disorder. This suggests that genetics do play a role.

Studies involving identical twins have suggested that environmental factors can contribute, as well. While some identical twins both develop a form of bipolar disorder such as cyclothymia, other sets of twins do not share the condition.

How Do You Test for Cyclothymic Disorder?

There is no specific test designed for cyclothymic disorder; instead, mental health professionals use a variety of screening questions and initial talk therapy sessions that may involve a client’s family history, personal experience history, and more. This process may take several sessions in order to determine what someone is suffering from. 

There may also be lab work done to rule out potential medical causes of symptoms. Timing is important as symptoms usually are present for approximately 2 years, without significant absence of symptoms. 

Treatment for Cyclothymic Disorder: Therapy and Psychiatric Choices

Therapy is integral in the treatment of cyclothymic disorder and can be administered in a few different ways. Two successful options include:

• Cognitive behavioral therapy (CBT) helps to identify the person’s unhealthy thoughts, feelings, and behaviors, and create healthier ones. CBT works to find the triggers of the symptoms and teaches the strategies for coping with stress and dealing with situations that are upsetting.
• Interpersonal and social rhythm therapy (IPSRT) focuses on stabilizing daily rhythms like sleep and mealtime. Correcting or managing lifestyle issues is important in treating cyclothymic disorder, in that a reliable routine works for better management of mood swings. Additionally, a set diet and exercise routine is helpful.

In addition to therapy—whether it’s CBT or IPSRT—it is crucial that those with cyclothymic disorder avoid recreational drugs and alcohol. Alcohol abuse is common in people with cyclothymic disorder because when they’re depressed, they feel that having a few drinks will result in the relief of their stress. However, alcohol only makes the mood swings caused by this disorder worse, and on top of that, it interferes with sleep.

Specific psychiatric options for people with cyclothymic disorder aren’t currently approved by the FDA, but that doesn’t mean people with cyclothymia are without options. If needed, a psychiatric provider will likely recommend a medication that’s approved for treating bipolar disorder I and II. 

Manic episodes can be treated with medications such as: 

• Quetiapine (Seroquel)
• Lithium 
• Lamotrigine 
• Venlafaxine (Effexor)
• Fluoxetine (Prozac)

In contrast, someone with cyclothymia who frequently suffers from depressive episodes can be treated effectively with: 

• Quetiapine 
• Lamotrigine
• Sertraline (Zoloft)
• And Bupropion (Wellbutrin)

Cyclothymic disorder can manifest as periods of depression and periods of hypomania that may not last as long as in the case of bipolar disorder I and II. Symptoms appear irregular and can be abrupt in nature, so if a prescription is recommended or required for a more balanced mood, having a consistent medication regimen is highly important.