Cyclothymia: Symptoms, Causes, and Treatment

08 May, 2020

The defining feature of cyclothymia (also called cyclothymic disorder) is chronic mood fluctuations or changes. You could say that it’s like bipolar disorder’s “little brother”.

For people with cyclothymia, the mood fluctuations consist of numerous, distinct periods of hypomanic and depressive symptoms. But the key feature is that the hypomanic symptoms are insufficient in number, severity, extent, or duration to complete the criteria of a manic episode.

The same thing occurs with the depressive symptoms. The depressive symptoms are insufficient in number, severity, extent or duration to complete the criteria of a major depressive episode. Otherwise, we would be discussing bipolar disorder. The similar but less severe symptoms are the reason why some people call cyclothymia bipolar disorder’s “little brother”.

Hypomanic and depressive symptoms

Hypomania refers to a state similar to mania, but less intense. Hypomania is a psychiatric episode with transient symptoms of irritability or excitement. It’s often described as a less intense or “incomplete” form of a manic episode.

Woman showing the two moods of cyclothymia
Hypomanic symptoms include a high mood that lasts several days. It also includes agitation, shortened sleep time, hyperactivity, and exaggerated self-confidence, all of which are considerably different from the person’s previous emotional state. Unlike mania, hospitalization for hypomania is normally not necessary.

As for cyclothymia’s depressive symptoms, they usually are similar to those of any depressed person. Nevertheless, these symptoms are normally not as noticeable or as intense as a major depressive episode.

Symptoms of cyclothymia or cyclothymic disorder

In addition, the symptoms must be persistent for the first two years of the disorder. Namely, be present on most days. For children and adolescents, they have to be persistent for one year instead of two.

In addition, the patient must not be symptom-free for more than two months. Symptom-free periods of longer than two months mean the person does not have cyclothymia. They must also not fit the criteria for major depression, mania, or hypomania. 

It’s also not cyclothymia if the mood fluctuation pattern is better explained by schizoaffective disorder, schizophrenia, a schizophrenic episode, a delusional disorder, and any schizophrenia spectrum disorder or other psychotic disorder. Basically, it shouldn’t fit the diagnostic criteria for another mental illness.

On the other hand, it’s important to not confuse cyclothymia with an altered mood state caused by a psychoactive drug or another medical condition. This is just as important to get an accurate diagnosis because some substances (drugs or medication) can trigger similar symptoms.

Like most psychological episodes, the patient must have clinically significant mood changes or impairment to be able to diagnose them with cyclothymia. The mood changes can affect or impair the patient’s social life, work, or other important aspects of their daily lives.

Cyclothymia diagnostic criteria

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), the following diagnostic criteria must be present for a diagnosis of cyclothymia:

  • Periods with hypomanic symptoms that don’t fit the criteria for a hypomanic episode, and numerous periods with depressive symptoms that don’t fit the criteria for a major depressive episode for at least two years (one year for children and adolescents).
  • During the previously mentioned two year period, the hypomanic and depressive periods must be present more than half the time and for at least six consecutive months. 
  • The symptoms have never fit the criteria for a major depressive episode or a manic or hypomanic episode. 
  • The symptoms aren’t better explained by schizoaffective disorder, schizophrenia, a schizophrenic episode, a delusional disorder, and any schizophrenia spectrum disorder or other psychotic disorder.
  • Symptoms cannot be attributed to the psychological effects of a substance (e.g. drug or medication) or other medical condition (e.g. hyperthyroidism).
Woman dealing with mood fluctuations

This disorder is often difficult to cope with and its quite chronic. In addition, patients with cyclothymia have a 15-50% risk of later developing bipolar I or bipolar II disorder. As we’ve seen, cyclothymia or cyclothymic disorder is related to bipolar disorderThe one major difference is that neither the hypomanic symptoms nor the depressive symptoms fit the criteria for a manic or major depressive episode.