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Cyclothymic Disorder

by William Coryell, MD

Cyclothymic disorder is characterized by hypomanic and mini-depressive periods that last a few days, follow an irregular course, and are less severe than those in bipolar disorder; these symptom periods must occur for more than half the days during a period of ≥ 2 yr. Diagnosis is clinical and based on history. Management consists primarily of education, although some patients with functional impairment require drug therapy.

Cyclothymic disorder is commonly a precursor of bipolar II disorder. However, it can also occur as extreme moodiness without becoming a major mood disorder. In chronic hypomania, a form rarely seen clinically, elated periods predominate, with habitual reduction of sleep to < 6 h. People with this form are constantly overcheerful, self-assured, overenergetic, full of plans, improvident, overinvolved, and meddlesome; they rush off with restless impulses and may act in an overfamiliar manner with people.

For some people, cyclothymic and chronic hypomanic dispositions contribute to success in business, leadership, achievement, and artistic creativity; however, they more often have serious detrimental interpersonal and social consequences. Consequences often include instability with an uneven work and schooling history, impulsive and frequent changes of residence, repeated romantic or marital breakups, and an episodic abuse of alcohol and drugs.

Treatment

  • Supportive care

  • Sometimes a mood stabilizer

Patients should be taught how to live with the extremes of their temperamental inclinations; however, living with cyclothymic disorder is not easy because interpersonal relationships are often stormy. Jobs with flexible hours are advised. Patients with artistic inclinations should be encouraged to pursue careers in the arts because the excesses and fragility of cyclothymia may be better tolerated there.

The decision to use a mood stabilizer (eg, lithium; certain anticonvulsants, especially valproate, carbamazepine, and lamotrigine) depends on the balance between functional impairment and the social benefits or creative spurts that patients may experience. Divalproex 500 to 1000 mg po once/day is often better tolerated than equivalent doses of lithium. Antidepressants should be avoided unless depressive symptoms are severe and prolonged because switching and rapid cycling are risks.

Support groups can help patients by providing a forum to share their common experiences and feelings.

Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • LAMICTAL
  • LITHOBID
  • TEGRETOL

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