Cyclothymia is a chronic mood disorder characterized by recurring mood swings that alternate between hypomanic and depressive episodes. These mood changes are less intense than those observed in bipolar disorder. For those living in Dubai, understanding cyclothymic disorder diagnosis and treatment is crucial, as cyclothymia can significantly disrupt daily life and personal relationships.
Symptoms often persist for several days, have an irregular course, and are milder than those of bipolar disorder. Alternating episodes of hypomania and mild depression often leave individuals feeling like their emotions are on a constant rollercoaster.
Cyclothymia often precedes bipolar disorder. It most commonly occurs in adolescence or early adulthood and affects about 0.4% to 1% of the U.S. population.
Due to its overlapping symptoms with other mental health conditions, cyclothymia is often underdiagnosed or misdiagnosed.
In the following article, we describe the diagnostic criteria and treatment of cyclothymic disorder at CHMC in Dubai.
For Treatment of Cyclothymia Schedule an Appointment with Our Leading Psychiatrist, Dr. Kowal
Read more about anxiety disorders:
- Bipolar Disorder, Diagnostic & Treatment
- What is Mania and Hypomania?
- History of Treatment of Bipolar Disorder
- CANMAT Guidelines of Bipolar Disorder Treatment with Medication
- Mood Stabilizers in Treatment of Bipolar Disorder
- Treatment with Lithium of Bipolar Disorder
Symptoms of Cyclothymic Disorder (Cyclothymia)
The primary symptoms of cyclothymia are frequent mood changes, swinging between hypomania and milder depressive episodes. Hypomanic episodes may present as feelings of euphoria, high energy, and irritability. Depressive episodes in cyclothymia are less pronounced than in bipolar disorder. They can appear as sadness, hopelessness, fatigue, and loss of interest in activities. These mood shifts can occur unpredictably and without warning, and they last shorter than in bipolar disorder.
In cases of chronic hypomania, a rarely observed variant, individuals may experience episodes of elevated mood and consistently reduced sleep duration of fewer than six hours. These individuals are often excessively cheerful, self-assured, energetic, and full of plans. They may act recklessly, overcommit to tasks, and behave intrusively toward others, often driven by restless impulses. While these traits may lead to success in business and leadership, they more commonly result in instability in relationships and personal life. Common consequences include a history of erratic career or education paths, impulsive relocations, repeated failed relationships, and episodic substance abuse.
Hypomanic Symptoms in Cyclothymia:
- Increased energy or activity
- Reduced need for sleep
- Unusually talkative behavior
- Racing thoughts or ideas
- Overconfidence or grandiosity
Depressive Symptoms in Cyclothymia:
- Sadness or hopelessness
- Loss of interest in activities
- Fatigue or low energy
- Difficulty concentrating
- Changes in appetite or sleep
Diagnosis of Cyclothymic Disorder
Diagnosing cyclothymia requires a thorough clinical examination, assessing the patient’s medical history, symptom patterns, and family history of mood disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires several criteria to make the diagnosis of cyclothymia. In cyclothymic disorder, there are numerous episodes of hypomanic episodes that do not meet the full criteria for a hypomanic episode and numerous episodes of depressive symptoms not meeting the criteria of major depressive disorder. These symptoms must be present for most of a two-year period, with no symptom-free stretch lasting longer than two months. Furthermore, the symptoms cannot be attributed to other psychiatric conditions, substance use, or medical disorders such as hyperthyroidism.
According to the DSM-5, six diagnostic criterions should be met:
Criterion A
For at least 2 years, there have been 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.
Criterion B
During the above 2-year period, the hypomanic and depressive periods have been present for at least half the time, and the individual has not been without the symptoms for more than 2 months at a time.
Criterion C
Criteria for a major depressive, manic, or hypomanic episode have never been met.
In the following criterions the symptoms
Criterion D
in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders.
Criterion E
are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
Criterion F
cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Differential Diagnosis of Cyclothymia
Differentiating cyclothymia from other mood disorders is essential, as certain medical or psychiatric conditions can mimic the symptoms of cyclothymic disorder. These include endocrine disorders, autoimmune diseases, vitamin deficiencies, electrolyte imbalances, infections, and traumatic brain injuries. Additionally, medications such as steroids, Parkinson’s medication, and some antibiotics can produce manic or depressive-like symptoms. Substance use, whether through intoxication or withdrawal, often leads to emotional changes that resemble cyclothymia.
Once organic causes are ruled out, clinicians need to differentiate between psychiatric conditions. Cyclothymia shares overlapping symptoms with several disorders, including major depressive disorder, bipolar II disorder, generalized anxiety disorder, neurodevelopmental disorders, and personality disorders. A thorough psychiatric evaluation is essential to clarifying these complex presentations.
Treatment for Cyclothymic Disorder with Psychotherapy
Psychotherapy, particularly Cognitive Behavioral Therapy (CBT), is highly effective for managing cyclothymia. CBT helps individuals:
- Improve emotional regulation
- Recognize triggers for mood swings
- Develop coping strategies
Treatment of Cyclothymic Disorder with Medication
Medication is not always necessary but may be beneficial if symptoms significantly impair daily functioning. Mood stabilizers like lithium or anticonvulsants such as lamotrigine can help control mood swings. In some cases, antipsychotics may be prescribed, though they require careful monitoring for side effects. Antidepressants are used cautiously due to the risk of triggering hypomania or rapid cycling and are generally reserved for severe and persistent depressive symptoms.
Lifestyle Changes in Prophylaxis of Cyclothymia
play a crucial role in managing cyclothymia. Regular physical activity, a balanced diet, and sufficient sleep are essential for maintaining mood stability. Stress reduction techniques such as mindfulness and meditation can also be effective. Support groups provide a space for individuals to share experiences and find encouragement from others facing similar challenges.
Causes of Cyclothymia
The exact cause of cyclothymia is unknown, but several factors may contribute to its development. Genetic predisposition plays a role, as individuals with a family history of mood disorders, particularly bipolar disorder, are at higher risk. Neurochemical imbalances in the brain can also affect mood regulation. Environmental factors, including stressful life events, trauma, and prolonged exposure to stress, may trigger or exacerbate symptoms, especially in those with a genetic predisposition.
Cyclothymic Disorder. Diagnosis and Treatment in Dubai. Summary
Cyclothymia, also known as cyclothymic disorder, is a milder form of bipolar disorder. Its symptoms are characterized by frequent mood swings between hypomanic and depressive episodes.
People with cyclothymia experience these mood changes for at least two years, often shifting quickly and unpredictably. Unlike the mood changes in bipolar I and II disorders, which typically occur over weeks, months, or even years, the mood shifts in cyclothymia can happen over much shorter periods—even within the same day. While individuals with cyclothymia may have brief periods of stable mood, these periods usually last less than eight weeks.
Cyclothymia’s chronic character requires ongoing management. Regular therapy sessions, medication adjustments, and a strong support network are vital for maintaining mood stability. With proper treatment, individuals with cyclothymia can lead fulfilling lives. While complete remission is rare, many people experience significant improvements in symptoms and overall quality of life. Early intervention and consistent management are key to achieving the best possible outcomes.