It’s a disorder that leaves you at the mercy of your moods, but tends to be subtle enough that you may not even understand you’re struggling with diagnosable symptoms. It’s not particularly common, and there’s not much information available.
Cyclothymia affects up to 1 percent of the population. However, at a hospital’s psychiatric department, it’s anywhere from 3 to 5 percent, according to Dr. Stephen B. Stokl, MD, Chief of Psychiatry at Southlake Regional Health Centre in Ontario.
Cyclothymia is marked by bouts of low-grade depression and hypomania, which includes elevated or irritable mood, decreased need for sleep and racing thoughts for at least four days. Adults are diagnosed after symptoms persist for two years. (Kids and teens are diagnosed after one year.) “Cyclothymia has an insidious onset that starts in late adolescence or early adulthood, and has a chronic nature,” Stokl said. It’s milder than bipolar I and bipolar II.
Most people never get treatment, according to John Preston, PsyD, professor at Alliant International University and author of three books on bipolar disorder, including Taking Charge of Bipolar Disorder. That’s because the depressions typically aren’t incapacitating, and people do feel OK for periods of time, he said. (But these periods don’t last longer than two months, which DSM-IV stipulates for the diagnosis.)
In other words, because symptoms tend to be less debilitating, people just don’t realize they have an illness, said Sheri Van Dijk, MSW, a psychotherapist and author of The DBT Skills Workbook for Bipolar Disorder. It’s usually loved ones who notice a problem, finding it hard to live with someone who has unstable moods, Preston said.
In fact, the toll on relationships can be dramatic. “Cyclothymia usually comes with a high morbidity in terms of breakdown in relationships both personal and at work,” Stokl said.
Also, if untreated, cyclothymia can get worse. “At least half of the people with cyclothymia, over a period of time, will start developing increasingly severe mood episodes,” and will be diagnosed with bipolar disorder, Preston said.
Diagnosing cyclothymia can be tricky. It may be misdiagnosed as bipolar NOS, bipolar II or borderline personality disorder, Van Dijk said. But individuals with bipolar II tend to struggle with more severe depression.
As Preston explained, there also are important differences between cyclothymia and borderline personality disorder. A person with borderline personality disorder may appear to be experiencing a hypomanic episode by acting upbeat and animated. But their elevated mood doesn’t last long and it always happens after becoming infatuated with someone new, he said. (Once the infatuation fades, they’re back to feeling dejected.)
The hallmark sign of hypomania is a decreased need for sleep, Preston said. People with hypomania only sleep for four or five hours. But they feel no fatigue, while those with borderline personality disorder become exhausted, he said.
Also, “People with borderline personality disorder are exquisitely sensitive to feeling rejected and abandoned,” he added.
The best way to diagnose cyclothymia – and bipolar disorders in general – is to get a comprehensive history of the person’s mood, which requires talking to both the person and a loved one who knows them very well, Preston said. Loved ones are usually better able to spot the mood changes, he said.
It’s essential that individuals who think they might have a mood disorder seek a professional evaluation. It’s also key for loved ones to understand that a person with cyclothymia can’t undo their disorder or control their mood shifts.
“Cyclothymia is driven by biological changes in the nervous system,” Preston said. However, fortunately, treatment is tremendously helpful in minimizing symptoms and leading a healthy, fulfilling life.
Coping with Cyclothymia
If you’re diagnosed with cyclothymia, learn as much as you can about the disorder. As Van Dijk said, “in order to deal with something effectively, you need to know what it is you’re dealing with.”
Talk with a mental health professional “about the symptoms, causes, triggers and treatment options,” she said. Find out “what [you] can expect and how to manage [your] symptoms more effectively,” she said.
Many experts, Preston said, advise against treating cyclothymia with medication. For one, mood stabilizers have troublesome side effects. Second, antidepressants are well-known for worsening cyclothymia in the long run, he said. (They can trigger hypomania.)
Preston stressed the importance of two major lifestyle issues in treating cyclothymia or any kind of bipolar disorder. One is maintaining healthy sleep patterns, because poor sleep activates mood episodes, he said. Avoiding caffeine after noon can dramatically improve your sleep. (You can download this helpful caffeine worksheet from Preston’s website.) If you’re feeling really tired, go for a 10-minute walk, which Preston said offers virtually the same amount of energy as a caffeine-filled drink.
The second is avoiding drugs and alcohol. Alcohol abuse is common with cyclothymia, he said. When people are depressed, they reach for a few drinks for relief. However, alcohol exacerbates mood disorders and sabotages sleep. While you’ll probably fall asleep faster, you’ll disrupt your quality of sleep. (Alcohol – along with caffeine – doesn’t let you progress to the deep, restorative stage of sleep.)
Psychotherapy also is highly effective. Research has found that both cognitive-behavioral therapy (CBT) and interpersonal social rhythm therapy (IPSRT) are helpful for treating bipolar disorders. Van Dijk and Stokl also noted that dialectical behavior therapy (DBT) is valuable.
Interpersonal social rhythm therapy focuses on two goals: improving relationships and creating healthy routines. According to Preston, relationships can be a significant source of stress for people with cyclothymia and may contribute to their mood episodes. Social rhythm therapy is similar to couples or family therapy and helps individuals learn better communication skills and solve their problems, he said. It also helps loved ones better understand that cyclothymia is a neurochemical disorder – not the person’s fault – and how it functions.
Routine is key for stabilizing moods, and people with bipolar disorders are especially sensitive to change. Any changes made to their eating, sleeping or exercise routines can interfere with their circadian rhythms and trigger an episode, Preston said.
That’s why it’s so important that all three are done on a regular basis. For instance, experts suggest going to bed and waking up at the same time each day. While this might seem tough and tedious, Preston said that it can help tremendously with regulating mood.
All these psychotherapies also help individuals learn effective coping skills, Van Dijk said. For instance, an individual might learn assertiveness skills to help their relationships and healthy strategies to process and manage emotions and avoid turning to problematic behaviors like substance abuse, she said.