Cyclothymia

Cyclothymia
Specialty	Psychiatry, clinical psychology

Cyclothymia (pronounced /ˌsaɪkləˈθaɪmiə, ˌsɪklə-/) is a mood disorder; a mild form of bipolar disorder. It is defined in the bipolar spectrum. Specifically, this disorder is a mild form of bipolar II disorder consisting of recurrent mood disturbances between hypomania and dysthymic mood. A single episode of hypomania is sufficient to diagnose cyclothymic disorder; however, most individuals also have dysthymic periods. The diagnosis of cyclothymic disorder is never made when there is a history of mania or major depressive episode or mixed episode (as told in "Blueprints in Psychiatry" - "mood disorders"). The lifetime prevalence of cyclothymic disorder is 0.4-1%. The rate appears equal in men or women, though women more often seek treatment.

Diagnostic criteria

DSM-IV-TR

• During the first two years of the disorder, the patient has not fulfilled enough criteria to qualify as having either bipolar disorder or major depressive disorder.
• Symptoms are present for at least two years: periods of hypomanic symptoms and periods of low mood that do not fulfill the criteria for major depressive disorder.
• The longest period the patient has been free of symptoms is two months.
• The disorder cannot be better explained as schizoaffective disorder, and it is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or psychotic disorder not otherwise specified.
• Symptoms are not directly caused by a general medical condition or the use of any substances such as prescription medicines.
• The symptoms cause the patient clinically significant distress or impair work, social or personal functioning.
• A person with this disorder may experience euphoric highs, boosts of energy and require less sleep in one phase, followed by a severe mood swings into a depressive state coupled with negativity & sadness for no particular reason.
• These mood swings are not as severe as bipolar I disorder or bipolar II disorder.
• Cyclothymia is to bipolar disorder as Dysthymia (a mild form of clinical depression) is to major depressive disorder.

ICD-10

A persistently unstable mood, involving many periods of mild depression and mild elation. This instability usually develops in late adolescence and follows a chronic course, although moods may be within norms for months at a time. Mood swings are usually perceived by the individual as being unrelated to life events. The diagnosis is difficult to establish without a prolonged period of observation or an unusually good account of the individual's past behaviour. Because the mood swings are relatively mild and the episodes of mood elevation may be enjoyable, cyclothymia frequently fails to come to medical attention. In some cases this may be because the mood change, although present, is less prominent than cyclical changes in activity, self-confidence, sociability, or appetitive behaviour. If required, age of onset may be specified as early (in late teenage or the twenties) or later.

The essential feature is a persistent instability of mood, involving numerous periods of mild depression and mild elation, none of which has been sufficiently severe or prolonged to fulfill the criteria for bipolar disorder or recurrent depressive disorder. This implies that individual episodes of mood swings do not fulfill the criteria for any of the categories described under manic episode or major depressive episode.

Differential diagnosis

This disorder is common in the relatives of patients with bipolar disorder and some individuals with cyclothymia eventually develop bipolar disorder themselves. It may persist throughout adult life, cease temporarily or permanently, or develop into more severe mood swings meeting the criteria for bipolar disorder or recurrent depressive disorder in rare cases.

Symptoms

Dysthymic phase

Difficulty making decisions; problems concentrating; poor memory recall; guilt; self-criticism; low self-esteem; pessimism; self-destructive thinking; continuously feeling sad; apathy; hopelessness; helplessness; irritable, quick temper; lack motivation; social withdrawal; appetite change; lack of sexual desire; self-neglect; fatigue or insomnia

Cyclothymic phase

Unusually good mood or cheerfulness (euphoria); Extreme optimism; Inflated self-esteem; Poor judgment; Rapid speech; Racing thoughts; Aggressive or hostile behavior; Being inconsiderate of others; Agitation; Increased physical activity; Risky behavior; Spending sprees; Increased drive to perform or achieve goals; Increased sexual drive; Decreased need for sleep; Tendency to be easily distracted; Inability to concentrate

Causes

Biological - Family - One is 2-3 times more likely to have the disorder if someone in the immediate family has it or if an identical twin has it. In a study by Bertelsen, Harvard, and Huage (1977), if an identical twin had depression 59% of the identical twins had it also.

- Gender – Heritability for women ranges from 36-44%; for men, 18-24%

- Genes - The same genes may contribute to depression and anxiety.

- Serotonin – Serotonin regulates other hormones like norepinephrine and dopamine, so when serotonin is low the other chemicals may fluctuate, causing irritability, impulsivity and mood irregularities such as dysthymia and depression.

- Cortisol – Depressed individuals usually have high cortisol levels. Cortisol is a stress hormone, and mood disorders often occur during stressful points in one’s life. Enduring high levels of stress hormones can shrink the hippocampus, the an important centre for short-memory and cognitive processes. Overproducing cortisol can also impair the brain’s ability to regenerate neurons.

Psychological - Stressful events, as perceived by the individual – job loss, relationship failure, identity change, natural disaster, learned helplessness and hopelessness, extreme feelings, negative thinking patterns

- Women ruminate over the problems, while men may involve themselves in another activity.

Social - Environment influences the disorder 60-80% of the time.

- Marital problems – in women it can cause depression because they value intimate relationships so much; for men they may withdraw from the relationship

- Parenting styles

Treatment

Exercise It has been repeatedly demonstrated that exercise can help with mood regulation and emotional stability.

Medications - Lithium – a mood stabilizer

- Anti-seizure medication/anti-convulsants – valproic acid, divalproex, and lamotrigine are options

- Antipsychotics

- Antianxiety medications (benzodiazepines) may improve sleep

- Antidepressants are not recommended because they can trigger a manic episode

Alternative Medicines

- Magnesium - symptoms of cyclothymia can resemble those of hypoglycemia, which is treatable with magnesium supplements.

- St. John’s Wort (hypericum perforatum) - It has been used for hundreds of years to treat anxiety and mood disorders. Used widely in Europe for mild depression. May not be as effective for severe depression.

- SAMe (S-adenosyl-methionine) – Used in Europe for depression, but like St. John’s Wort, it is not controlled by the American FDA. SAMe can be expensive; trimethylglycine (TMG) is a less expensive alternative that the body can use to create SAMe on its own.

- Omega-3 Fatty Acids – Rich foods include fish (salmon, mackerel, herring), nuts (flaxseed, flax oil, walnuts), eggs, and oils (canola, soybean).

Therapy

- Cognitive Behavioural Therapy (CBT)

- Interpersonal Therapy (IT)

- Group therapy

Mind-Body Techniques - Yoga

- Acupuncture

- Meditation

- Guided Imagery

- Massage Therapy

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See also

• Dysthymia
• Euthymia
• Motivation
• Ultradian Bipolar Disorder

External links

• Psychnet UK Cyclothymic Disorder information sheet
• Cyclothymia Symptoms from CounsellingResource.com
• Cyclothymia from Psycom.net
• Cyclothymia from McmanWeb
• What Is Cyclothymia? from Mental Health Matters
• Mental Health Matters: Cyclothymia from Mental Health Matters
• Cyclothymia Workbook from All About Depression
• Bipolar4all UK support site
• Cyclothymia : Through The Patient's Eyes useful course module