Cyclothymic disorder

What is cyclothymic disorder?

Cyclothymic disorder, also known as cyclothymia, is a mental health disorder which affects mood. People with the condition experience mood swings between ‘highs’ and ‘lows’ that have the potential to interfere with everyday life.

Cyclothymic disorder is considered to be a type of bipolar disorder, though the mood swings are not as severe or prolonged as bipolar I or bipolar II disorders.[1][2]

See the resource on bipolar disorder for more information.

Cyclothymic disorder affects between 0.4% and 1% of the population, affecting women more often than men by a ratio of 3:2.[3][4]

Cyclothymic disorder usually begins early in life and is manageable with treatment. Less than half of people with the condition will go on to develop bipolar disorder. Some people will experience cyclothymic disorder as a chronic condition which lasts a lifetime, while others will find it goes away over time.[5]

Symptoms

People with cyclothymic disorders experience frequent swings between high and low mood. These swings are extreme enough to be classified as hypomania and depression, though not as extreme as those found in bipolar disorder.

The frequency of mood swings in cyclothymic disorder is higher than in bipolar disorder. There may be no periods of stable mood between episodes, and periods of stable mood will last for less than two months. Depressive symptoms will have lasted for at least two years or one year for children and teenagers. High and low moods will be experienced for at least half the time.[6][7]

People with cyclothymic disorder tend to have extreme reactions to external events or stimuli. They can be overly happy and enthusiastic in response to a positive event, such as:[8]

  • Success at work
  • A period of good weather
  • Feelings created by substances, like drugs and alcohol

They can also be overly pessimistic and depressed by negative events, such as:

  • A relationship setback
  • Onset of winter
  • Stressful situations, such as moving house

Hypomania

People with cyclothymic disorder can experience hypomania, which is a feeling of exaggerated happiness or wellbeing (euphoria). It is not as extreme as mania. Someone experiencing hypomania may appear to be managing day-to-day activities well, though it can still be disruptive.[8][9][10]

Symptoms and signs of hypomania in cyclothymic disorder can also include:

  • Being irritable and agitated
  • Impulsive and risky behaviour
  • Extreme optimism
  • Lack of inhibitions and poor judgement
  • Racing thoughts and talking more than usual
  • Increased sexual drive
  • Easily distracted
  • Overly confident and inflated sense of self-esteem
  • Not sleeping much
  • Excessive physical activity or fidgeting

Unlike bipolar disorder, hypomania in cyclothymic disorder will not develop into mania.[3]

Depression

Someone with cyclothymic disorder will experience depression, which is characterized by low mood. These feelings are more intense and longer-lasting than the feelings of sadness that everyone experiences from time to time.

Symptoms and signs of depression in cyclothymic disorder can include:[8][11][12]

  • Low mood for most of the time
  • Feeling hungrier than usual
  • Weight changes
  • Feeling very fatigued and sluggish
  • Sleeping more or less than usual
  • Not enjoying life and activities, even ones normally found pleasurable
  • Feeling upset or tearful
  • Lack of concentration or motivation
  • Feeling guilty or worthless
  • Loss of interest in sexual activity and intimacy
  • Loss of interest in activities and hobbies
  • Being irritable, agitated or tense
  • Being restless
  • Suicidal thoughts and feelings

Mixed episodes

People with cyclothymic disorder have a high tendency towards experiencing depression combined with the high energy of hypomania. This is known as a mixed state or mixed episode.[8][11]

Mixed episodes can be difficult to cope with, because the emotional experience is confusing. Someone in a mixed state also poses a greater risk of attempted suicide, as the person may feel the sadness and hopelessness of depression while in an energized state.[6]

Causes of cyclothymic disorder

It is not known what causes cyclothymic disorder. However, people with the condition often have relatives with bipolar disorder, and there is thought to be a hereditary link.[5][13]

Risk factors for cyclothymic disorder

Cyclothymic disorder can develop into bipolar disorder. This is thought to occur in less than half of people with the condition.[5][13]

People with cyclothymic disorder are more likely to misuse substances such as alcohol and illegal drugs, e.g. cocaine. This is caused by reduced impulse control during high moods and heightened reactions to experiences that are perceived as pleasurable.[8][14]

The instability of cyclothymic disorder can increase the risk of suicide. This is because of moods shifting relatively rapidly between depression and feeling energized, as well as a tendency towards extreme emotional reactions.[8][15][16]

Diagnosing cyclothymic disorder

Cyclothymic disorder shares some characteristics with bipolar disorder, but is less intense. This can feel as though the condition is being classified as not serious, when in fact it can have a significant impact on a person’s life.[2]

The ICD-10[17] defines cyclothymic disorder as having numerous periods of depression and mild elation, or hypomania, none of which are severe, or extended enough, to be classified as bipolar disorder.[13]

DSM-5 criteria[18] defines cyclothymic disorder as having the same mood swings as the ICD-10, but notes that:[8][7]

  • A person should have had many periods of hypomania, and periods of depression for at least two years, or one year in children and teenagers
  • Stable moods should last for less than two months at a time
  • Symptoms do not meet the criteria for bipolar disorder or another mental health condition
  • Symptoms are not caused by another medical condition or by substance misuse
  • Symptoms significantly affect day-to-day life

Diagnosis will be made by taking a medical history, possibly in discussion with a psychiatrist. Blood and urine tests may be carried out to eliminate physical causes for the mood swings. For example, hyperthyroidism may also cause mood swings.[5][19]

Treatment of cyclothymic disorder

A person with cyclothymic disorder can require treatment even during periods of stable mood. Treatment should be guided by a mental health provider with experience in treating the condition.

If necessary, cyclothymic disorder should be treated with psychotherapy combined with appropriate medication.

Psychotherapy

Psychoeducation is a talking treatment that helps one gain insight into a condition and its effects.[20] Cyclothymic disorder may be a pleasurable experience for some people, and psychoeducation can help bring about acceptance that the condition needs to be treated.[8]

Other talking therapies, such as support groups or cognitive behavior therapy (CBT),[21] can help someone with cyclothymic disorder manage the condition and prevent it affecting day-to-day life. The duration of psychotherapy sessions will depend on clinical need.[5][22]

Long-term psychotherapy can help by:[6]

  • Instigating healthy daily routines
  • Developing strategies to cope with extreme emotional responses
  • Rebuilding self esteem

Medication

Whether to treat cyclothymic disorder with medication, and what kind of medication to use, depends on how difficult the person with the condition finds day-to-day life.

Mood stabilizers can work by evening out the high and low mood swings. Commonly prescribed mood stabilizers include valproic acid, lamotrigine and lithium. However, people with cyclothymic disorder may not respond as well to medication as people with bipolar disorder.[3]

When prescribed on their own for people with cyclothymic disorder, antidepressants can potentially trigger manic episodes or increase the frequency of episodes. If antidepressants are used as a treatment they should be used in conjunction with a mood stabilizer.[8][22]

For more information about these medications, see the resource on bipolar disorder.

Life-long medication may not be necessary. The goal is to achieve a significant period of stable mood, such as six months to one year. If stability can be maintained through psychotherapy, the person under treatment may be able to stop taking medication. However, this decision should be made in conjunction with a medical professional.[8][22]


  1. National Institute of Mental Health. “Bipolar disorder.” April 2016. Accessed April 24, 2018.

  2. Mind. “Bipolar disorder.” October 2015. Accessed April 24, 2018.

  3. Psychology Today. “Cyclothymic Disorder.” March 2018. Accessed April 24, 2018.

  4. European Medical Alliance. “Epidemiology of Cyclothymic Disorder.” November 2016. Accessed May 6, 2018.

  5. MedlinePlus. “Cyclothymic disorder.” July 2016. Accessed April 24, 2018.

  6. Neuropsychiatry. “Should cyclothymia be considered as a specific and distinct bipolar disorder?” 2012. Accessed April 24, 2018.

  7. Mayo Clinic. “Cyclothymia.” April 2018. Accessed April 24, 2018.

  8. US National Library of Medicine. “Diagnosis and Treatment of Cyclothymia: The “Primacy” of Temperament” April 2017. Accessed April 24, 2018.

  9. Mind. “Hypomania and mania.” August 2016. Accessed April 24, 2018.

  10. Patient Info. “Bipolar Disorder.” August 2017. Accessed April 24, 2018.

  11. Mind. “What are bipolar mood states?” October 2015. Accessed April 24, 2018.

  12. National Institute of Mental Health. “Depression.” February 2018. Accessed April 24, 2018.

  13. World Health Organization. “ICD-10: Chapter V.” 2003. Accessed April 24, 2018.

  14. US National Library of Medicine. “Psychopathology in drug abusers and their families.” 1991. Accessed April 24, 2018.

  15. US National Library of Medicine. “Suicidal intentionality, attempts and cyclothymic temperament.” April 2008. Accessed April 24, 2018.

  16. US National Library of Medicine. “Association between suicidal behaviour and cyclothymic temperament in patients with recurrent depressive disorder.” August 2013. Accessed April 24, 2018.

  17. International Statistical Classification of Diseases and Related Health Problems, tenth revision.

  18. Diagnostic and Statistical Manual of Mental Disorders, fifth edition.

  19. MedlinePlus. “Hyperthyroidism.” October 2014. Accessed April 24, 2018.

  20. Mind. “What treatments can help?” October 2015. Accessed April 24, 2018.

  21. Mind. “Cognitive behavioural therapy.” October 2017. Accessed April 24, 2018.

  22. MSD Manual: Professional Version. “Cyclothymic Disorder.” August 2016. Accessed April 24, 2018.