Cyclothymic disorder is commonly a precursor of bipolar II disorder Bipolar Disorders Bipolar disorders are characterized by episodes of mania and depression, which may alternate, although many patients have a predominance of one or the other. Exact cause is unknown, but heredity... read more . 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 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 is clinical and based on history.
(See also Overview of Mood Disorders Overview of Mood Disorders Mood disorders are emotional disturbances consisting of prolonged periods of excessive sadness, excessive joyousness, or both. Mood disorders can occur in children and adolescents (see Depressive... read more .)
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.
The decision to use a mood stabilizer (eg, lithium Lithium Choice of drug treatment for bipolar disorders can be difficult because all drugs have significant adverse effects, drug interactions are common, and no drug is universally effective. Selection... read more ; certain anticonvulsants Anticonvulsants Choice of drug treatment for bipolar disorders can be difficult because all drugs have significant adverse effects, drug interactions are common, and no drug is universally effective. Selection... read more , 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 orally once a 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.
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