Cyclothymic disorder is commonly a precursor of bipolar II disorder Bipolar Disorders Bipolar disorders are characterized by alternating episodes of mania and depression, although many patients have a predominance of one or the other. Exact cause is unknown, but heredity, changes... 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.
(See also Overview of Mood Disorders Overview of Mood Disorders Mood disorders are emotional disturbances consisting of prolonged periods of excessive sadness, excessive elevated mood, or both. Mood disorders can occur in adults, adolescents, or children... read more .)
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
Also, the symptoms are not attributable to another psychiatric disorder (eg, schizoaffective disorder Schizoaffective Disorder Schizoaffective disorder is characterized by psychosis, other symptoms of schizophrenia, and significant mood symptoms. It is differentiated from schizophrenia by occurrence of ≥ 1 episode of... read more , delusional disorder Delusional Disorder Delusional disorder is characterized by firmly held false beliefs (delusions) that persist for at least 1 month, without other symptoms of psychosis. Delusions are distinguished from mistaken... read more ) or the psychological effects of a substance (eg, schizoaffective disorder Schizoaffective Disorder Schizoaffective disorder is characterized by psychosis, other symptoms of schizophrenia, and significant mood symptoms. It is differentiated from schizophrenia by occurrence of ≥ 1 episode of... read more ) or other medical condition (eg, hyperthyroidism Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremor... read more )
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
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.
The decision to use a mood stabilizer (eg, lithium Lithium Choice of pharmacologic agents to treat bipolar disorders can be difficult because all medications can potentially have significant adverse effects, drug interactions are common, and no medication... read more ; certain antiseizure medications Antiseizure Medications Choice of pharmacologic agents to treat bipolar disorders can be difficult because all medications can potentially have significant adverse effects, drug interactions are common, and no medication... 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. Oral divalproex 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
|Eskalith, Eskalith CR, Lithobid
|Carbatrol, Epitol , Equetro, Tegretol, Tegretol -XR
|Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR, Subvenite