• Understanding Cyclothymia

    IMAGE Cyclothymia is a disorder characterized by numerous periods of elevated or irritable mood alternating with mild depression. Sometimes such changes impair the person's social or work life. Other times, the highs can aid productivity and creativity.

    Excessive Behavior

    People with cyclothymia might clean house nonstop for hours. Sleep eludes them. They do not feel tired. During highs, feelings of elation, irritability, or anger occur. Relationships are strained. Decision-making is flawed. They may go on buying sprees or make foolish investments.
    "There's a lot of goal-directed behavior that's excessive," says cyclothymia researcher Lyn Abramson, PhD. She is a professor of clinical psychology at the University of Wisconsin, Madison. "They might start projects when they don't have money to do the project."

    Two Forms of the Disorder

    Patients typically fall into two groups. Some find the disorder helps them function. During highs, they can work longer hours and ideas come easily. "They are not impaired with the high," Dr. Abramson explains. "They're facilitated by it. If the depression is not too debilitating, they function better than average."
    There is another subgroup of people with cyclothymia whose work life is seriously impaired during the high phases of cyclothymia. Those folks become distracted. Or they make bad decisions.
    Certain events can trigger a cycle. For instance, a job interview may get a person with cyclothymia too charged up. That leads to high symptoms. They also may overreact to failure—that leads to depression.
    Most people with the condition face mood changes every few days, and some cycle more rapidly. Symptom-free periods rarely exceed two months.
    This condition is a mild form of bipolar disorder. For those with cyclothymia, the symptoms are less intense and do not last as long.
    Ups are not as high and downs are not as low as in a full-blown bipolar disorder. Although, some people with cyclothymia eventually develop the symptoms of more serious bipolar disease.
    Bipolar disease and cyclothymia tend to run in families. There may be a genetic link between the two. Differences in temperament may also come into play.

    Occurrence

    Cyclothymia often becomes apparent during adolescence or early adulthood. It affects men and women equally. National Depressive and Manic-Depressive Association board member Thomas L. Schwenk, MD, says patients rarely seek treatment from their doctor for mild mood cycling. Dr. Schwenk is also professor and chair of the Department of Family Medicine at the University of Michigan.
    "Cyclothymia is a very odd diagnosis that is ignored, either because it doesn't have significant functional impact or other psychiatric or medical comorbidity (conditions) supersedes it," explains Dr. Schwenk. "In primary care, other medical and psychiatric problems often take priority."
    Patients may voice concern about depression. However, downs typically do not last long enough for antidepressants to be useful. And the drugs may set off a severe hypomanic or up episode.

    Help for Mood Swings

    Some patients try self-medicating with alcohol. But drinking or drugs worsen the risk of suicide.
    Patients who seek psychiatric care may receive medicines normally used to treat bipolar disorder. Generally, other medicines, like mood stabilizers, are recommended instead of antidepressants. This is because antidepressants can trigger manic episodes. If you do need to take an antidepressant, often another medicine is combined with it.
    Patients often do not want to lose the improved functioning they experience during a 'high'. "Some people like the periods of being up," Dr. Schwenk explains. "They have a lot of trouble with treatment because they are not sure they want to be treated, or they don't want to be labeled as having a disease."
    Even when medicine lacks appeal, counseling can help buffer the ups and downs. Therapists may suggest maintaining a regular schedule: wake up, eat, and go to bed at the same times. Other techniques include avoiding situations that trigger cyclothymic episodes and developing strategies for controlling responses to events. Still other therapies focus on improving relationships.
    For anyone noticing a cyclic mood pattern: "Go to a psychiatrist, and emphasize you're not just experiencing depression but also highs," advises Dr. Abramson. "If patients comply with treatment, it often can help."

    RESOURCES

    Depression and Bipolar Support Alliance http://www.dbsalliance.org/

    National Institute of Mental Health http://www.nimh.nih.gov/

    CANADIAN RESOURCES

    Canadian Psychiatric Association http://www.cpa-apc.org/

    Mood Disorder Association of Canada http://www.mooddisorderscanada.ca/

    References

    Cyclothymia: treatment and drugs. MayoClinic.com website. Available at: http://www.mayoclinic.com/health/cyclothymia/DS00729/DSECTION=treatments%2Dand%2Ddrugs. Updated April 2008. Accessed August 4, 2008.

    DynaMed Editors. Cyclothymia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Published date. Updated February 22, 2010. Accessed June 3, 2010.

    Factsheet: mood disorders. Mental Health America website. Available at: http://www.mentalhealthamerica.net/index.cfm?objectid=C7DF96B5-1372-4D20-C868380DE081DCAB. Updated November 2007. Accessed August 4, 2008.

    4/29/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Nivoli AM, Colom F, Murru A, et al. New treatment guidelines for acute bipolar depression: a systematic review. J Affect Disord. 2011;129(1-3):14-26.

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