Cyclothymia

What is cyclothymia?

Cyclothymia is like a mild form of bipolar disorder. You have weeks of low level depression and episodes of mild mania.

How does it occur?

A few children may have cyclothymia. It usually starts during young adult years. Men and women are about equally likely to have cyclothymia. Less than 1% of the population has it.

The exact causes of the disorder is unclear. However, it does run in families. If you have relatives with bipolar disorder or cyclothymia, you are more likely to have it.

Parts of the brain may not work normally during manic and depressive episodes. But exactly what triggers these switches is unclear.

What are the symptoms?

During the manic periods you have several days when you may:

• Have a very high self-worth and feel "on top of the world."
• Be very talkative and talk fast, maybe so fast that others have trouble following what you are saying.
• Have racing thoughts and ideas to the point of being disorganized and muddled.
• Have trouble concentrating and find yourself jumping between different ideas.
• Be very restless and hyperactive.
• Have more anxiety and panic.
• Go for days with little or no sleep without feeling tired.
• Be very irritable and get into fights with others.
• Have bursts of high interest in sex and sexual activity.
• Be too active and act recklessly. For example, you might spend all your money and go into debt, or take sudden trips.

The symptoms of depression last a few weeks. Besides feeling somewhat sad and uninterested in things, you may also:

• Be irritable and aggressive.
• Have trouble falling asleep, wake up very early, or sleep too much.
• Have little or excessive appetite.
• Be easily tired and low in energy.
• Have low sexual desire and function.
• Feel worthless and guilty.
• Have trouble concentrating or remembering things.
• Feel hopeless or just not care about anything.
• Have unexplained physical symptoms.

You may also have mixed periods when you feel a combination of both manic and depressed phases.

One phase may be followed immediately by the other. Often there is a period of feeling good between the two. If feeling good lasts more than 2 months, then you do not have cyclothymia.

How is it diagnosed?

Your healthcare provider or a mental health therapist will ask about your symptoms and any drug or alcohol use. You may have lab tests to rule out medical problems such as hormone imbalances.

The pattern in adults must last for at least 2 years to be called cyclothymia. For children and adolescents, symptoms that last for a year may be cyclothymia.

How is it treated?

Psychotherapy, medicines, or both, are the best treatment.

Medicines

Your healthcare provider will work with you to choose the best medicine for you.

The most commonly used medicines are:

• lithium carbonate (Lithium)
• valproic acid (Depakote)
• oxcarbazepine (Trileptal)
• lamotrigine (Lamictal)
• carbamazepine (Tegretol).

Sometimes you may need other medicines. For example an antidepressant, an antipsychotic, or an antianxiety medicine may give you the best results.

Psychotherapy

Seeing a mental health therapist is helpful. Therapy may be needed for many months. Cognitive behavioral therapy (CBT) is a form of psychotherapy that is especially helpful. CBT is a way to help you identify and change thought processes that lead to depression. Replacing negative thoughts with more positive ones can help your depression.

Complementary Treatments

Diets rich in fruits and vegetables are recommended for people with mood disorders. A multivitamin and mineral supplement may also be recommended.

Studies suggest that eating fatty fish 2 to 3 times per week may reduce feelings of depression and anxiety. These fish contain omega-3 polyunsaturated fatty acids. Fatty fish include salmon, tuna, mackerel, herring, and sardines. Fish oil capsules are available. Flaxseed, pumpkin seed, walnuts, and olive oil are also sources of omega-3 fatty acids.

St. John's wort may help with some forms of mild depression. It does not help with severe depression, and may cause side effects, such as sun sensitivity, anxiety, or trouble sleeping.

Other supplements that may be helpful in treating depression include SAMe, DHEA, and 5-hydroxytryptophan.

Be careful which products you use. "Natural" products are not standardized. They may have different strengths and effects. Some may be contaminated. Herbs and supplements affect your body and may interact with prescription medicines. Talk to your healthcare provider or pharmacist about any supplements that you are using or considering.

Other treatments that may help mood problems are:

• Biofeedback. Through biofeedback you learn to control body functions such as muscle tension or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration, and indirectly may help depression. Biofeedback, like relaxation therapies, are helpful when used with psychotherapy and medicine.
• Massage Therapy. Massage therapy may help lower stress, but it does not cure cyclothymia.
• Relaxation Therapies. Learning ways to relax can help depression, along with medicines and psychotherapy. Yoga and meditation may also be helpful.
• Art and Music Therapies. Some people find art and music therapy, along with medicines and psychotherapy, are helpful in treating cyclothymia.

How long will the effects last?

Cyclothymia often lasts for many years. You may need treatment throughout your life. It is important to follow your prescribed treatment every day.

What can I do to help myself or my loved one?

• Take your medicine daily, even if you are feeling well. Stopping your medicine when you feel well may cause symptoms to return.
• Watch yourself for the beginning signs of either an over-excitement or depressive phase. Ask others around you to also watch closely.
• Eat a healthy diet.
• Keep your sleep and exercise routines even when you travel.
• Avoid alcohol and mood altering drugs. These often set off phases.
• Don't drink a lot of caffeine.
• Check with the healthcare provider treating you for cyclothymia before taking other medicines. He or she can tell you if there is any conflict with your cyclothymia medicines.

When should I seek help?

If you are showing the signs of either a manic or depressive phase, seek professional help. Most of the time, you will feel much better after a few weeks of treatment.

Get emergency care if you or a loved one has serious thoughts of suicide or harming others. Also get emergency help if manic behavior becomes so wild that it endangers you or others.

For more information, see:
Bipolar Disorder
Cognitive Therapy