Cyclothymia (cyclothymic disorder): causes, symptoms, and treatments

Cyclothymia, or cyclothymic disorder, is a milder type of bipolar disorder that also involves mood changes, such as emotional highs and lows. These alterations in mood might last for days, weeks, or even months, and may prevent the affected person from performing everyday tasks.

The causes of cyclothymia include genetics, changes in brain structure and function, and environmental issues.

The symptoms of cyclothymia involve depressive and manic/hypomanic episodes. The depressive symptoms of cyclothymic disorder include irritability, aggressiveness, feelings of hopelessness, worthlessness, or guilt, changes in appetite, sleep problems, low sexual desire and function, weight loss or gain, unexplained physical symptoms, inattentiveness, lack of concentration, or forgetfulness, and fatigue or low energy.

On the other hand, its hypomanic symptoms are euphoric feelings, heightened self-esteem, extremely upbeat, getting distracted easily, being more talkative than usual, flustered thinking, reduced need for sleep, poor judgment resulting in risky behavior or bad decisions, agitation or irritability, difficulty focusing, heightened motivation to perform or accomplish sexual, work-related, or social goals, and an excessive amount of exercise.

The available treatments for cyclothymia include cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), and medications.

What is cyclothymia?

Cyclothymia is a mild mood disorder with chronic symptoms that bear similarities with those observed in bipolar disorder. Cyclothymic disorder can also cause emotional ups and downs, although relatively mild. However, because of its chronic nature, it still has a significant impact on an individual’s life and functioning.

If you have cyclothymia, you’ll experience periods of low moods followed by periods of exaggerated sense of happiness or well-being, which are called depressive and hypomanic episodes, respectively. These symptoms, however, fall short of meeting the complete criteria for bipolar disorder or major depressive disorder, according to a continuing education activity on cyclothymic disorder by Joseph E. Bielecki and Vikas Gupta published in 2022 on StatPearls.

What is the other term for cyclothymia?

The other term for cyclothymia is cyclothymic disorder. Cyclothymia symptoms tend to be less severe than those of bipolar disorder, but they are more persistent.

Although thought of as milder, the emotional disturbances involved in cyclothymic disorder can still interfere with the affected person’s daily functioning and cause personal and work relationship issues.

When does cyclothymia start?

Cyclothymia starts during adolescence or early adulthood. In some cases, however, onset may be as early as childhood, according to a 2012 study on cyclothymic disorder in youth by Anna R. Van Meter and Eric A. Youngstrom published in Neuropsychiatry (London).

Unfortunately, many experts believe that cyclothymia is under diagnosed and misdiagnosed due to the fact that its symptoms closely resemble that of other mental health conditions. Some people also do not seek professional help because their symptoms are only mild.

Where is cyclothymia most common?

Chapter 7 of the book entitled, “Global Emergency of Mental Disorders,” by authors Jahangir Moini, Justin Koenitzer, and Anthony LoGalbo published in 2021 by Elsevier Science, states that there is no obvious racial or ethnic preference present in those with cyclothymic disorder. Cyclothymia affects 20% to 50% of patients who suffer from depression, anxiety, and associated diseases.

The prevalence of this condition is also almost equally distributed across men and women, however women seem to seek therapy more frequently. About 50% of clinically depressed patients evaluated at outpatient psychiatric clinics had a diagnosis of cyclothymia.

How common is cyclothymia?

Cyclothymia is a rare mental health condition. According to an article entitled, “Cyclothymia (Cyclothymic Disorder)” published in WebMD, cyclothymia affects 0.4% to 1% of Americans.

Cyclothymic disorder can easily be misdiagnosed due to overlapping diagnostic criteria with other personality disorders. Healthcare providers also typically find it difficult to diagnose the condition, as its onset is hard to identify.

What are the causes of cyclothymia?

The causes of cyclothymia include different contributing factors that play a role in its development. The causes of cyclothymia are listed below.

• Genetics
• Differences in the way the brain works
• Environmental issues

1. Genetics

Genetics is the science of genes and heredity and how variations in DNA sequence cause specific characteristics or traits to be transferred from parents to children, as stated by a fact sheet on Genetics published in the National Institute of General Medical Sciences.

Heredity becomes a cause of cyclothymic disorder by putting a person at a higher risk of developing the condition if it runs in the family. Strong evidence links genetic elements to the development of cyclothymia.

The concordance rate of 57% observed in monozygotic twins provides evidence for this influence. Numerous loci are currently the subject of genotypic research, including 18p11, 13q32, the CLOCK genes, and ANK3, as stated by a continuing education activity on cyclothymic disorder by Joseph E. Bielecki and Vikas Gupta published in 2022 on StatPearls.

There are, however, other factors that play a role in the development of cyclothymia, and having a blood relative with the same condition does not automatically mean you will develop it.

Genetics is regarded as one of the causes of cyclothymia because the susceptibility of an individual to any disease or illness is passed on in families through genes.

2. Differences in the way the brain works

The term for changes in brain structure and function that occur over time is neuroplasticity. Neuroplasticity refers to the capacity of the brain to change and adapt in response to experiences.

It becomes a cause of cyclothymia by causing neuroplastic changes in the brain brought about by genetics, early childhood experiences, and traumatic life events.

Differences in the way the brain works are considered a cause of cyclothymic disorder because these changes in brain structure and function influence how the brain deals with stress, habits, decision-making, and other life stressors.

3. Environmental issues

Environmental issues refer to conditions in a person’s social, economic, racial, and interpersonal relationships that may affect how well they can handle stress, according to an article entitled, “How Environmental Factors Impact Mental Health,” from Wellmore Behavioral Health.

These environmental issues may include traumatic life events or high levels of stress. That said, these environmental factors become a cause of cyclothymic disorder by negatively influencing an individual’s overall mental well-being.

Finally, environmental issues are considered one of the factors that may lead to the development of cyclothymia because they can contribute to poor social support, low self-esteem, decreased energy levels, and difficulty making decisions – all of which reduces a person’s quality of life in many ways.

What are the depressive symptoms of cyclothymia?

The depressive symptoms of cyclothymia occur during a period of low mood in people with the condition. The depressive symptoms of cyclothymia are listed below.

• Irritability
• Aggressiveness
• Feelings of hopelessness, worthlessness, or guilt
• Changes in appetite
• Insomnia or hypersomnia (sleeping too much)
• Low sexual desire and function
• Weight loss or gain
• Unexplained physical symptoms
• Inattentiveness, lack of concentration, or forgetfulness
• Fatigue or low energy

1. Irritability

Irritability is defined as a feeling of agitation that causes someone to be easily frustrated, annoyed, and lose patience, especially over small things. It is considered a symptom of several mental health conditions.

Feeling irritable becomes a symptom of cyclothymia when it turns extreme enough that it starts affecting an individual’s social and general functioning. Extreme irritability can have a major impact on relationships, making it difficult for those with the condition to build and maintain strong relationships with other people.

Additionally, irritability is regarded as one of the indicators of cyclothymic disorder because those who suffer from cyclothymia often experience this emotion, describing it as angry outbursts or periods of extreme, unrestrained anger, according to a 2008 review article on spectrum disorder written by Jyoti Prakash and A.K. Mitra and published in Delhi Psychiatry Journal.

Irritability can also be identified in someone with cyclothymia by looking out for its signs, including frustration, restlessness, difficulty concentrating, and feeling annoyed, grumpy, and frustrated.

2. Aggressiveness

Aggressive behavior refers to any activity or action intended to hurt a person, an animal, or cause physical change or structural damage to property. Examples of aggressive acts include shouting, harsh language, hitting, kicking, swearing, and sending threatening messages.

Aggression becomes an indicator of cyclothymia when it stems from a manic episode, where a person may present with high energy and may become overtaken by their own exaggerated sense of self.

This can hinder their capacity for empathy and encourage a sense of entitlement, including the authority to take advantage of or exploit others, as explained by Kimberly Brown, PhD, ABPP, an associate professor of clinical psychiatry and behavioral sciences at Vanderbilt University Medical Center, in an article entitled, “Mental illness and violence: Debunking myths, addressing realities” from the American Psychological Association.

Furthermore, aggressive or violent tendencies are considered a part of the symptoms of cyclothymic disorder because they are common features of the condition that tend to interfere with one’s thought processes.

Aggressiveness can be identified in a person by recognizing its signs, including hitting, punching, slapping, throwing insults or cruel remarks, bullying, gossiping, redirecting blame, and giving the silent treatment.

3. Feelings of hopelessness, worthlessness, or guilt

Feelings of hopelessness, worthlessness, or guilt are also called excessive self-blaming moral emotions that stem from blaming oneself for failure in an overgeneralized way, as stated by a study on learned helplessness in humans by Abramson et al., published in the Journal of Abnormal Psychology.

Self-blaming moral emotions become a symptom of cyclothymia by enabling depressive symptoms, which can manifest as feeling bad or guilty about being depressed, or feeling like a burden to loved ones because of their situation.

Irrational feelings of hopelessness and guilt are also considered signs of cyclothymic disorder because they make someone more vulnerable to an overall increase in negative emotions that contribute to the depressive symptoms of cyclothymia.

Feelings of hopelessness, worthlessness, or guilt can be identified in an individual by looking out for warning signs, such as lack of sleep, issues with digestion, muscle tension, neglecting personal hygiene, low self-esteem, fear of making the wrong decision, and being highly sensitive to the consequences of every action.

4. Changes in appetite

Changes in appetite may describe either an increase or decrease in a person’s desire to eat food. Aside from appetite changes, cyclothymia can also affect the types of food one eats.

Increased or decreased appetite can become a symptom of cyclothymic disorder if they result from low mood and negative self-image, which are common features of the condition.

Appetite changes are regarded as an indicator of cyclothymia because they are often seen in individuals with the disorder, and they also contribute to disordered eating, which typically co-occurs with bipolar disorder.

Recognizing appetite changes during depressive phases is possible by looking out for its signs, such as weight loss or gain, changes in physical activity, negative perception of oneself, impulsivity, emotional reactivity, and low self-esteem.

5. Insomnia or hypersomnia (sleeping too much)

Insomnia is a sleep disorder that makes it difficult for an individual to fall asleep, stay asleep, and achieve a restorative sleep, while hypersomnia is difficulty maintaining wakefulness and alertness during the day, despite getting enough sleep at night.

These sleep disturbances become a symptom of cyclothymia by predicting the onset of a manic episode, as they are often the first symptoms to appear before the oncoming episode.

Insomnia or hypersomnia are considered indicators of cyclothymic disorders because they are some core symptoms of the condition, and they are the most common signs that a period of mania is about to occur.

Changes in sleep can be identified in an individual by observing its symptoms, including excessive daytime sleepiness, trouble falling asleep or maintaining sleep, nightmares, sleep talking, and poor sleep quality.

6. Low sexual desire and function

Low sexual desire refers to having little to no interest in sexual activity. Contrary to hypersexuality or increased sexual activity experienced during episodes of mania, lower sex satisfaction indicates a depressive episode.

Sex drive issues become a symptom of cyclothymia by ultimately affecting an individual’s ability to date and their success in keeping a long-term relationship.

These issues are also considered a sign of cyclothymic disorder because they are not only a result of the condition itself, sex drive issues can also stem from the very medications used to treat the condition.

Finally, recognizing low sexual desire and function is possible by looking out for its signs, such as disinterest in initiating sex, inability to get pleasure from sex, rarely or never having sexual fantasies, and decreased responsiveness to stimulation.

7. Weight loss or gain

Weight loss is defined as a decrease in one’s overall body weight, while weight gain refers to an increase in body weight. These changes in weight are related to the changes in appetite that are also involved in cyclothymia.

Changes in weight become a symptom of the condition due to the fact that they stem from the changes in appetite and eating habits that are very common during a depressive episode.

Weight loss or gain is also considered a sign of cyclothymic disorder because they can also be a side effect of taking medications for the condition, which can increase one’s blood sugar level.

In identifying weight change, one has to look for its symptoms, which can include rapid weight gain, difficulty breathing, fatigue, sweating, shortness of breath, poor appetite, nausea, unexplained stomach aches, low energy, and altered mood.

8. Unexplained physical symptoms

Unexplained physical symptoms are medically unexplained physical complaints regarding bodily sensations or physical dysfunctions, which may be localized to a particular bodily region or generalized, as stated by an article entitled, “Somatic symptom disorder” from Neuroscience Research Australia (NeuRA).

Medically unexplained somatic symptoms become an indicator of cyclothymia by causing people to significantly focus on physical symptoms, such as excessive fatigue or sleep problems, to the point that their thoughts about their bodily sensations cause them distress or disruption in their daily living.

Somatic symptoms are also considered a sign of cyclothymic disorder because patients with the condition often report having such symptoms. In fact, according to a 2016 systematic review and meta-analysis of medically unexplained somatic symptoms and bipolar spectrum disorders published in the Journal of Affective Disorders, people with bipolar disorders experience somatic symptoms at a rate nearly double that of the general population.

Recognizing if someone is suffering from unexplained physical symptoms may be possible by watching out for some signs, including persistent anxiety about their symptoms, having symptoms that worry them excessively and/or disrupt their daily life, cause pain, weakness, and shortness of breath.

9. Inattentiveness, lack of concentration, or forgetfulness

Inattentiveness, lack of concentration, or forgetfulness are some examples of issues with memory, thinking, and concentration that patients with cyclothymia often report experiencing.

Impairments in memory and thinking are considered a symptom of cyclothymia as several studies have found that individuals with bipolar disorder have reported memory impairment during periods of depression and mania, and at times in between, according to a study on cognitive and neurological impairment in mood disorders by Cherie L. Marvel, PhD and Sergio Paradiso, MD, PhD published in the Psychiatric Clinics of North America.

Changes in thinking and memory are also regarded as indicators of cyclothymic disorder because individuals with the condition tend to experience a fall-off in cognitive functions with every mood episode they have, which results in a pattern of progressive or even accelerated decline in cognitive skills over time.

To identify problems with memory, thinking, and concentration due to cyclothymia, it is important to know its signs, such as difficulty remembering things, trouble concentrating, anxiety, racing thoughts, and in some instances, psychosis.

10. Fatigue or low energy

Fatigue refers to an overall feeling of tiredness or low energy that can have physical and/or mental causes. It is a common symptom of cyclothymia, making it difficult for patients to function in everyday life.

Fatigue becomes a symptom of cyclothymia when it occurs as a result of fluctuations between manic and depressive phases. The symptom can happen in both episodes, making it difficult for an individual to function through the day.

Low energy is regarded as a sign of cyclothymic disorder because the mental toll of having to live through the condition as well as other symptoms that accompany it can be exhausting, not only mentally, but also physically.

Fatigue can be recognized in an individual suffering from cyclothymia by looking out for symptoms, such as chronic tiredness or sleepiness, slowed reflexes and responses, lack of motivation, trouble focusing, muscle weakness, and lack of desire to engage in activities once enjoyed.

What are the hypomanic symptoms of cyclothymia?

The hypomanic symptoms of cyclothymia include activities or behaviors that are characterized by elevated energy or mood that is significantly different from one’s usual state of mind. The hypomanic symptoms of cyclothymia are listed below.

• An overinflated sense of joy or well-being (euphoria)
• Heightened self-esteem
• Extremely upbeat
• Tendency to get sidetracked easily
• Talking more than usual
• Flustered thinking
• Fewer hours needed to sleep
• Having poor judgment that can lead to risky behavior or bad decisions
• Agitation or irritability
• Inability to pay attention
• Heightened motivation to perform or accomplish goals (sexual, work-related, or social)
• An excessive amount of exercise

1. An overinflated sense of joy or well-being (euphoria)

Euphoria is a feeling or state of great happiness, confidence, or well-being. Although not a mental health problem on its own, it can sometimes be a sign of a mental health condition.

It becomes a symptom of cyclothymia by being a result of the condition and being accompanied by other symptoms. A euphoric mood is also regarded as an indication of cyclothymic disorder because it is commonly experienced by people suffering from the condition during a manic episode.

An overinflated sense of well-being can be recognized in an individual by spotting the signs of a euphoric mood, which include inflated self-esteem, extreme optimism, talking more than usual, engaging in risky behaviors, reduced need for sleep, and racing thoughts.

2. Heightened self-esteem

Heightened self-esteem is when one believes in their capabilities and has a positive opinion about themselves. It may be a good trait on its own, but if it stems from a mental health issue, a high self-esteem may have negative consequences.

An inflated self-esteem becomes a symptom of cyclothymic disorder when it is experienced during a hypomanic episode, where an individual may be extremely confident yet unrealistic about their abilities.

For instance, someone with cyclothymia may feel a sense of entitlement and think that the rules do not apply to them when they are in a hypomanic phase. High self-esteem is also considered a symptom of cyclothymia because it often precedes or is experienced during a hypomanic episode of the condition.

Furthermore, according to a 2016 meta-analysis of the clinical characteristics of pediatric mania and hypomania published in the journal Bipolar Disorders, about 57% of youth with bipolar disorder experience grandiosity or inflated self-esteem.

Heightened self-esteem can be identified in a person by looking out for common signs, such as an exaggerated sense of self-importance, acting selfishly, wanting to be the center of attention, being unable to see how their behavior affects others, and a desire to be recognized as important or special.

3. Extremely upbeat

Being extremely upbeat means feeling more cheerful or optimistic than usual. An individual with cyclothymia may appear very lively or upbeat during a hypomanic episode.

Being abnormally upbeat can become a symptom of cyclothymic disorder if it results in an individual being so adventurous or leads them to believe that everything will work out just fine that they engage in risky behaviors, such as gambling, substance use, or being involved in violent crime.

Feeling extremely energized is also regarded as a sign of cyclothymia because this symptom goes beyond just a normal good mood. For instance, someone with the condition may feel overly excited about situations that do not warrant feelings of excitement, such as taking out the trash.

This means that the person is just stuck in cheerful mode and does not have complete control over their response to the environment.

Finally, being extremely upbeat can be recognized by observing its signs, including increased excitement, energy, impulsive behavior, being uncontrollably excited even over things that do not warrant it, and excess activity levels.

4. Tendency to get sidetracked easily

A tendency to get sidetracked easily refers to trouble concentrating or paying attention, that an individual’s thoughts or attention are easily drawn away.

Distractibility becomes a symptom of cyclothymia by causing changes in thinking that are prominent in both hypomanic and depressive episodes. It is also considered an indication of cyclothymic disorder because this lack of concentration can make it harder for someone to function at school, work, or at home.

It can also affect relationships in those areas of your life, as people around you may think you are just being inconsiderate of them because you find it difficult to pay attention to anything they are saying.

In identifying lack of concentration in someone with cyclothymia, it is important to look out for its signs, including inability to accomplish usual daily tasks, mental cloudiness, difficulty making decisions, forgetfulness, committing careless mistakes on routine tasks, and difficulty thinking clearly.

5. Talking more than usual

Excessive talking is the practice of over speaking or chatting compulsively. An individual in a hypomanic phase may talk excessively and rapidly without interruption, and they may not give the other person a chance to talk or talk over them.

Pressured speech becomes a symptom of cyclothymia when one feels a compulsive urge to share their thoughts, ideas, or comments about a certain topic that their speech would just come out rapidly without pausing at appropriate intervals, just like they would during conversation.

Compulsive talking is also regarded as a sign of bipolar cyclothymic disorder because it is commonly experienced by people living with the condition, as this form of bipolar disorder might make it hard for them to filter constant thoughts, resulting in oversharing.

Excessive talking can be identified by watching out for common signs, such as talking more than usual, speaking at a faster pace or a higher volume, feeling unable to control the words flowing out of you, and not allowing others to get a word in during conversation.

6. Flustered thinking

Flustered thinking refers to an inability to think clearly or difficulty thinking with focus. In terms of cyclothymia, this symptom is more commonly known as brain fog. Brain fog is characterized by symptoms, such as disorganized thinking and memory lapses.

Brain fog becomes a symptom of cyclothymic disorder by negatively affecting an individual’s thinking ability, causing it to be less sharp than before the onset of their symptoms.

Fuzzy thinking is considered a sign of cyclothymia because it goes hand in hand with other numerous mood and behavioral symptoms that characterize the condition.

Recognizing brain fog is possible by looking out for its signs, including impaired cognitive function, difficulty learning new information, trouble concentrating, low energy, and forgetfulness.

7. Fewer hours needed to sleep

Decreased need for sleep is a symptom of cyclothymia in which one can function with little to no sleep and not experience fatigue the following day. High energy levels and restlessness experienced during a manic episode can make it difficult for an individual to sleep at night.

Poor sleep patterns become a symptom of cyclothymia because the episodes of the condition disturb one’s sleep cycle in a lot of ways. For instance, someone who is used to sleeping eight hours may feel rested with only four hours of sleep when they are in their manic phase.

Sleep disturbances are also regarded as a sign of cyclothymic disorder because they tend to persist even in between episodes and may even contribute to illness relapse.

A decreased need for sleep may be recognized if an individual can go by without much sleep, sometimes staying awake for 20 hours, yet does not feel tired at all the following day.

8. Having poor judgment that can lead to risky behavior or bad decisions

Poor judgment refers to a lack of ability to make sound decisions. During a hypomanic episode, poor judgment can lead to impaired decision-making, and may ultimately result in engaging in risky behaviors.

Impaired judgment becomes a symptom of cyclothymia when it leads the affected individual to take unsafe risks. This clouded judgment can cause problems they did not expect and did not intend, but as thinking gets more difficult for someone with cyclothymia, they may not always consider the consequences of their actions.

This makes them more likely to engage in self-harm, try drugs, drink alcohol, or have sex with strangers without protection.

Poor judgment is considered a sign of cyclothymic disorder because it is a hallmark of the condition, and because it can also stem from another symptom called racing thoughts. Due to the mind having excessive thoughts, an individual finds it difficult to pause and think hard to decide about something.

In identifying impaired judgment, it is crucial to look for warning signs, such as engaging in inappropriate behavior, displaying a notable change in behavior, lowered inhibitions, clouded thinking, and risk-taking behavior.

9. Agitation or irritability

Agitation is described as a more severe form of irritability. A person who is agitated may appear disturbed, nervous, or upset.

Agitation becomes a symptom of cyclothymic disorder when it is brought on by little or no provocation, and if it is involved in the mood changes that happen in the condition.

Being agitated is regarded as a sign of cyclothymia because it is a common manifestation of the disorder and many other mental health conditions. Most of the time, people with cyclothymia are aware that they are becoming agitated and what their triggers are.

Recognizing agitation in a loved one is possible by watching out for its signs, including restlessness, tension, angry outbursts, irritability, difficulty focusing, excessive talking, and impulsive behavior.

10. Inability to pay attention

Inability to pay attention means that someone has trouble focusing or staying on a certain task and easily gets distracted. People with cyclothymia may have problems with their attention span and focus as they go through the phases of the disorder.

Attention impairment becomes a symptom of the condition by being the most compromised function in those with bipolar disorder, as modifications in learning, memory, and visuospatial skills often stem from attention deficit, according to a systematic review on attention impairment in bipolar disorder by Camelo et al., published in Psychology & Neuroscience.

Difficulty paying attention is regarded as an indicator of cyclothymic disorder because it tends to interfere with many areas of a person’s life.

One can identify if a person is having trouble paying attention if they seem to not last very long on a given task, or they find it difficult to perform normal tasks that they usually do.

11. Heightened motivation to perform or accomplish goals (sexual, work-related, or social)

Heightened motivation is defined as a tendency to approach or accomplish a desirable goal. During a manic phase, individuals diagnosed with cyclothymia can have extreme emotional reactions, be clever and creative, and possess strong cognitive ability, as stated by an article entitled, “High achievers more likely to be bipolar” published in Medical Xpress.

Goal engagement becomes a symptom of cyclothymic disorder by contributing to an affected person’s over-responsivity to success, which results in them responding to incentive cues with excitement and energy.

Furthermore, goal pursuit is regarded as a sign of cyclothymia because it happens as a result of the surges of confidence experienced by those with the condition during a hypomanic phase.

Being highly motivated in pursuing goals can be identified in a person with the disorder if they seem to be setting extremely high goals, committing great resources to achieving those goals, and if they are responding to goal progress or obstruction in more prolonged ways, as suggested by a study on the consequences of goal pursuit in bipolar disorder published in 2012 in the journal Clinical Psychology & Psychotherapy.

12. An excessive amount of exercise

Excessive amount of exercise is defined as exaggerated exercise volumes that are beyond the healthy amount the body needs. While regular, moderate exercise is believed to have a positive impact on one’s mood, there has been a debate on the effects of excessive physical activity on those with bipolar disorder and its other forms.

Vigorous exercise may become an indication of cyclothymia if it brings on a hypomanic episode. According to an article entitled, “Can Exercise Cause Mania?” from PsychCentral, it is still unclear even to experts whether a manic episode causes someone to engage in intense physical activity, or whether vigorous exercise causes a manic episode.

However, an unhealthy amount of exercise may be regarded as a sign of cyclothymic disorder because the two may have a bidirectional relationship, which means one may cause the other, and the other may cause the first.

It may be possible to recognize if someone is engaging in vigorous physical activity if they tend to overdo exercising or have uncontrollable desires to exercise that it takes up a huge amount of their time and leaves them with reduced activities in other areas of life.

Who is at risk for cyclothymia?

Individuals with blood relatives diagnosed with bipolar or cyclothymic disorder and those who experienced traumatic life events are at an increased risk for cyclothymia. The genetic component of cyclothymic disorder is strong, and a family history of the condition or other mental health problems may indicate a greater risk of development.

On the other hand, environmental factors such as traumatic life events and high levels of stress may also increase one’s likelihood of developing cyclothymia.

What can I expect from cyclothymia?

With cyclothymia, you can expect to experience periods of depressive symptoms that alternate with hypomania, or an elevated mood state. You might feel stable and okay in between these emotional highs and lows, although in certain cases, some symptoms may persist.

During cyclothymic highs, you may feel extreme happiness and excitement when you are very energetic and do not require a lot of sleep. On the other hand, during cyclothymic lows, you may experience low mood for most of the time and a lack of motivation to engage in daily routines or activities, even ones you normally find enjoyable.

How is cyclothymia diagnosed?

Cyclothymia is diagnosed by using different tools, such as a physical exam, psychological evaluation, and the criteria for cyclothymic disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Your healthcare provider may conduct a physical exam, including lab tests, to rule out other medical conditions that could be contributing to your symptoms. If other conditions have been ruled out, your provider may perform a psychological evaluation, or they may refer you to a mental health professional, to talk about your symptoms, thoughts, and behavior patterns.

Lastly, your psychiatrist or psychologist may use the criteria for cyclothymia listed in the DSM-5 to arrive at a more accurate diagnosis. According to the DSM-5, a diagnosis of cyclothymia requires that numerous periods of hypomanic and depressive symptoms be present for at least two years (one year in children and adolescents), and that these mood disturbances do not satisfy the criteria for bipolar disorder or major depression.

The psychiatry text also requires that the emotional highs and lows occur at least 50% of the time and that phases of stable moods do not endure longer than two months. Finally, symptoms should not be a result of substance use or a medical condition.

What are the available treatments for cyclothymia?

The available treatments for cyclothymia are used even during phases when one feels stable or fine. The available treatments for cyclothymia are listed below.

• Cognitive behavioral therapy (CBT)
• Interpersonal and social rhythm therapy (IPSRT)
• Medications

1. Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a form of psychotherapy that teaches patients how to identify and challenge self-defeating thought patterns and behaviors and replace them with positive ones.

CBT helps treat cyclothymia by identifying trigger points and helping patients learn effective stress management techniques to cope with their triggers. It is also considered as one of the treatments for cyclothymic disorder because it aims to change the negative thinking patterns that arise during mood episodes, which leads to changing how individuals feel and respond to their emotions.

CBT is a commonly used and therefore an effective treatment for cyclothymia, especially when combined with medications. In general, improvements in patients’ condition can be seen after 5 to 20 sessions of CBT.

2. Interpersonal and social rhythm therapy (IPSRT)

Interpersonal and social rhythm therapy (IPSRT) is specifically designed for people with bipolar disorder to help minimize disruptions to their relationships and daily routines, which can help improve their mood and mental health.

IPSRT helps treat cyclothymia, a milder form of bipolar disorder, by addressing the circadian rhythm disruptions that are very common in people with the condition. It is also a treatment for cyclothymic disorder because it emphasizes the importance of developing and maintaining daily routines – such as sleeping and waking up – in managing shifting moods and behavior.

According to results from a real-world, controlled trial on the efficacy of IPSRT in patients with bipolar disorder published in 2020 in the Annals of General Psychiatry, IPSRT has been shown to improve the clinical symptoms of bipolar patients.

IPSRT typically consists of 12 weekly sessions that last approximately 90 minutes each.

3. Medications

Medicines are substances that are ingested into (or administered to) the body with the intention of curing, treating, or relieving symptoms of an illness or disease. The Food and Drug Administration (FDA) has not approved any drugs especially for cyclothymia.

But occasionally, medical professionals will recommend a mood stabilizer to manage your mood fluctuations. These drugs could consist of lithium, valproate, and/or lamotrigine.

Aside from mood stabilizers, other types of medications used to treat cyclothymia may also include anti-seizure medications, atypical antipsychotics, anti-anxiety drugs, and antidepressants.

It is important to note, however, that experts generally avoid prescribing antidepressants because they may trigger harmful manic episodes when taken alone. This is why they are typically taken with a mood stabilizer, as indicated in a 2018 article entitled, “What is Cyclothymia?” from Healthline.

Medications help treat cyclothymic disorder by assisting in controlling the high and low emotions experienced in the condition. These medicines are also one of the treatments for cyclothymia because they are usually the first line of treatment for the disorder.

Although mood stabilizing drugs are known to be effective in preventing both hypomania and depressive states, they may also have negative effects that you might want to discuss with your doctor.

It may take two weeks or longer after you begin taking mood stabilizers for you to start noticing their effects, and it may take four to six weeks for them to fully take effect.

What are the complications of cyclothymia treatment?

The complications of cyclothymia treatment, particularly the use of mood stabilizers, include nausea, diarrhea, dry mouth, weight gain, increased thirst or urination, irregular heartbeat, mild tremors, lethargy, and kidney and thyroid issues.

Antidepressant medications are also rarely used in treating cyclothymia, and its potential side effects include increased mood cycling, weight gain, emotional numbness, nervousness, agitation, erectile dysfunction, loss of libido, and feelings of being addicted to the medication.

Can cyclothymia be treated?

Yes, cyclothymia can be treated with the help of different treatment options, such as cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), and medications like mood stabilizers.

These treatment options available for patients with cyclothymic disorder help control or lessen their symptoms and improve their quality of life.

How to prevent having cyclothymia?

There is no proven way to prevent cyclothymia. However, cyclothymia can be kept from getting worse by receiving therapy as soon as onset of symptoms first appears.

Long-term preventative care can also assist in preventing mild symptoms from developing into severe depressive, manic, or hypomanic episodes.

What is the difference between cyclothymic disorder and bipolar disorder?

The main differences between cyclothymic disorder and bipolar disorder are the severity of symptoms, duration of mood episodes, diagnostic criteria, impact on daily functioning, and risk of psychosis.

One of the key differences between cyclothymic disorder and bipolar disorder is the severity of symptoms. People with cyclothymic disorder have mood swings that aren’t as extreme and can sometimes be confused for just being moody. Bipolar disorder, on the other hand, has more severe or intense symptoms.

The duration of mood episodes for the two conditions are also different. Cyclothymic disorder patients often suffer from short-lived episodes, where mood shifts may occur from one day to the next, or even within the same day, whereas bipolar patients encounter episodes that can range from days to weeks, according to a 2022 article entitled, “What’s the Difference Between Cyclothymia and Bipolar Disorder? Published in Healthline.

To get a diagnosis of cyclothymic disorder, a person must have hypomanic and depressive signs many times over at least two years (one year for children and teens). Meanwhile, a person must have at least one episode of either mania or hypomania, as well as depressive episodes, to be diagnosed with bipolar disorder.

Cyclothymic disorder typically has a less severe impact on daily functioning than bipolar disorder. Cyclothymic disorder may impede social or vocational functioning, however most people may function successfully. Bipolar disease, on the other hand, can make it hard for someone to work, keep relationships, or do basic tasks.

Finally, bipolar patients are more likely to develop psychosis than cyclothymic patients. Psychosis is characterized by a loss of reality awareness. It may include hallucinations, delusions, and distorted thinking. Those with cyclothymia may have milder variations of these symptoms during hypomanic episodes, although they seldom develop psychosis.