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.
Cyclothymic disorder is commonly a precursor of bipolar II disorder. 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.)
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):
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, delusional disorder) or the psychological effects of a substance (eg, schizoaffective disorder) or other medical condition (eg, hyperthyroidism)
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.
The decision to use a mood stabilizer (eg, ; certain antiseizure medications
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.
