Merck Manual

Please confirm that you are a health care professional

honeypot link

Cyclothymic Disorder

By

William Coryell

, MD, University of Iowa Carver College of Medicine

Reviewed/Revised Oct 2023
View PATIENT EDUCATION

Cyclothymic disorder is characterized by hypomanic and mini-depressive symptoms 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 years. Diagnosis is clinical and based on history. Management consists primarily of education, although some patients with functional impairment require medications.

In chronic hypomania, a form rarely seen clinically, elated periods predominate, with habitual reduction of sleep to < 6 hours. 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.

Diagnosis of Cyclothymic Disorder

Diagnosis of cyclothymic disorder is based on the following diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision, which must have been present for at least 2 years (1 Diagnosis reference Cyclothymic disorder is characterized by hypomanic and mini-depressive symptoms that last a few days, follow an irregular course, and are less severe than those in bipolar disorder; these symptom... read more ):

  • Numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

  • Symptoms have been present for at least half of the 2-year period and the individual has not been without symptoms for more than 2 months at a time

Diagnosis reference

  • 1. Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC, pp 160-163.

Treatment of Cyclothymic Disorder

  • 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 might perhaps be encouraged to pursue careers in the arts because the excesses and fragility of cyclothymia may be better tolerated there.

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
Eskalith, Eskalith CR, Lithobid
Carbatrol, Epitol , Equetro, Tegretol, Tegretol -XR
Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR, Subvenite
View PATIENT EDUCATION
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
quiz link

Test your knowledge

Take a Quiz! 
iOS ANDROID
iOS ANDROID
iOS ANDROID
TOP