Definition

Cyclothymia is considered in the category of Bipolar Disorders and is thus classed as a Mood Disorder in the DSM-IV. It can be generally distinguished from Bipolar Disorder by the chronicity (long-term duration) and moderate severity of its symptoms, and by its early onset. Essentially, it can be considered more relenting and less consuming than Bipolar Disorder.

The central feature of this disorder is a chronic mood disturbance of at least two years (one year in the case of children and adolescents) involving numerous episodes of Hypomania and depressed mood that are insufficiently severe enough to warrant a diagnosis of Major Depression or Mania. Diagnosis is also contingent upon a person not being without symptoms for more than two months within the two year period; further, there must be no evidence of a major depressive or manic episode occurring during this period, nor another mental disorder, organic condition or substance use. The boundaries between this disorder and Bipolar Disorder are far from being clear-cut. For this reason, some researchers are inclined to believe that Cyclothymia is a mild form of Bipolar Disorder.

Hypomanic episodes appear to have little impact on social or occupational functioning; in fact, individuals may actually function productively during these periods. Depressive episodes may resemble those of Dysthymia; consequently, there may be some impairment in social and occupational functioning. Sufferers may also be susceptible to substance use as a means of coping with the disorder or as an indulgence during hypomanic periods. Current clinical evidence suggests that the disorder is equally likely amongst males and females and its prevalence has been estimated at approximately 0.4% to 3.5% in the general population. Further, some long-term follow-up studies of patients with Cyclothymia have indicated that there may be a 33% risk that the disorder will develop into Bipolar Disorder.

Symptoms

• Recurring hypomanic episodes as well as periods of depressed mood or loss of interest or pleasure
• Individuals are never without the hypomanic or depressive symptoms for more than two months during a two year period (one year for children and adolescents)

Cause(s)

Depressive conditions may be precipitated by the interaction of a number of factors:

For example, research has indicated that individuals can inherit a predisposition to develop depressive conditions. Individuals who have family members who have suffered from depression may have an increased risk of contracting such disorders themselves.

Imbalances or impaired functioning in the brain's neurochemical systems associated with mood and activity can also have a striking effect on thoughts, emotions and behavior. A variety of drugs are presently available to help correct such neurochemical abnormalities.

A host of environmental factors may also give rise to depressive conditions. Disappointment, stress and/or trauma resulting from such things as unemployment, personal failure or tragedies, and family breakdown, can all precipitate depression.

Certain psychological factors may also contribute to the development of depression. For example, behavioral explanations have suggested that depression may be a product of "learned helplessness" that arises from a repeated loss of positive reinforcement and a, perhaps, increased rate of negative life events, among other things. More cognitive-oriented explanations suggest that depression can be exacerbated and maintained by negative and/or unrealistic beliefs and attitudes about the self, the world and the future.

Course

Cyclothymia typically occurs in early adulthood. Its onset is usually gradual and its course chronic. Hypomanic and depressive symptoms can overlap or alternate within a matter of hours, days, weeks, or months. Intermittent periods of relatively normal mood can also occur, but if a diagnosis is to be valid, these periods can only last for up to two months.

Treatment

Bipolar Disorder and Cyclothymia can often be treated with medication as well as counseling and, sometimes, electroconvulsive therapy (ECT).

Medication for the manic episodes of Bipolar Disorder includes mood stabilizers (typically "Lithium"), anticonvulsants, and antipsychotics. If warranted, sufferers of Cyclothymia may also be prescribed these classes of drugs; lithium, however, may be the most commonly prescribed medication for this disorder. Antidepressants are prescribed for depression. Variability of effects, however, may require that different products be tried for optimum effects. Antidepressants may also cause hypomania or mania and are thus frequently prescribed with mood stabilizers. Regular monitoring of prescriptions and dosages is very important.

Several counseling approaches, including cognitive and behavioral psychotherapy, have also proved to have some efficacious value in treating these disorders. The major focus of the aforementioned therapies is to decrease the frequency and severity of episodes, and to identify and modify habitual, maladaptive patterns of thought and/or behavior, in addition to providing support and access to further resources.

In some treatment-resistant cases, Electroconvulsive Therapy (ECT) has proved to be a successful treatment for the more extreme symptoms of Bipolar Disorder. ECT involves the application of a mild electric current sufficient to induce seizure to a region of the skull (typically in the right hemisphere near the temporal lobe) under very controlled conditions. The nightmare media depictions of ECT undertaken in past decades are by no means accurate today. Great steps are taken to ensure that no harm comes to those undergoing this type of therapy. ECT is usually considered as a later resort in difficult cases.

Dealing with Relapse

During a period of stability and wellness, individuals should devise a relapse management plan with their mental health professional and family members or friends that will outline what steps may need to be taken should a relapse occur. The plan will need to identify symptoms that may constitute warning signs and, if they are evident, an agreement should be made by the individual and members of his or her immediate support network to contact the family physician, counselor, or other mental health professional. In addition, methods to reduce stress and stimulation should be established with a counselor so that they can be put into effect pending any relapse.

Emergencies

In the case of an emergency, individuals should call their physician, therapist, or the emergency ward of their local hospital. Additional assistance may also be obtained by clicking on the Further Information and Support link below.

Further Information and Support (Coming Soon)