Cyclothymia

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KEY POINTS

• Cyclothymia causes you to go back and forth frequently between mild mania (feeling highly energized and very active) and mild depression (feeling sad, hopeless, and low energy).
• Treatment may include medicines, therapy, and learning ways to manage stress. In severe cases, you may need to be treated in the hospital.
• If you are depressed and feel that you could hurt yourself or someone else, call your healthcare provider or therapist right away.

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What is cyclothymia?

Cyclothymia is a condition that causes you to go back and forth frequently between mild mania and mild depression. In the manic phase you feel highly energized and are very active. In the depressed phase you are very sad, hopeless, and just don’t care about anything.

What is the cause?

The exact cause of the disorder is not known. Possible causes include:

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• People with this disorder may have physical changes in their brain. These changes may mean that some parts of the brain are more active or less active than in other people.
• Cyclothymia tends to run in families. Stress plays a part.
• Some medicines can cause depression or manic symptoms. These include some blood pressure medicines, diet pills, and steroids such as prednisone.
• Alcohol and drug abuse can trigger symptoms.

Cyclothymia usually starts during the young adult years and can last a lifetime. Men and women are about equally likely to have cyclothymia.

What are the symptoms?

During any 2-year period you have either mild mania or depression almost constantly.

During the manic periods, symptoms may include:

• Have an unrealistic belief that you are unusually smart, creative, or can do amazing things
• Be very talkative and talk so fast that others have trouble following what you are saying
• Have racing thoughts
• Have trouble concentrating and jump between different ideas
• Take on lots of new projects often without finishing any of them.
• Having more feelings of anxiety and panic
• Going for days with little or no sleep and not feeling tired
• Being very irritable and getting into fights with others
• Being extremely active and acting recklessly, such as going on spending sprees
• Being more interested in sex or having unsafe sex

The symptoms of depression last a few weeks. During a period of depression, symptoms may include:

• Feeling sad and uninterested in things you usually enjoy
• Being irritable
• Having trouble falling asleep, waking up very early, or sleeping more than usual
• Noticing changes in your appetite and weight, either up or down
• Feeling very tired or low energy
• Losing interest in sex
• Feeling worthless and guilty
• Not being able to concentrate or remember things
• Feeling hopeless or just not caring about anything
• Having physical symptoms, such as headaches and joint pain
• Thinking often about death or suicide

You may also have what is called a mixed episode. A mixed episode is mania with depressed symptoms at the same time. In a mixed episode you may be overly active, withdraw from others, feel worthless, be irritable, and cry often.

You may go from one phase right into the other. Often there is a period of feeling good between the two. If you have cyclothymia, feeling good lasts less than 2 months at a time.

How is it diagnosed?

Your healthcare provider or therapist will ask about your symptoms. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

How is it treated?

Cyclothymia can be successfully treated with therapy, medicines, or both. It often lasts for many years, and if not treated, it tends to get worse. The mania and depression can be more severe and episodes happen more often. Sometimes it becomes bipolar disorder.

Medicines

Several types of medicines can help treat cyclothymia. Your healthcare provider will work with you to select the best medicine. You may need to take more than one type of medicine.

Therapy

Combining medicines with therapy is often the best approach.

• Cognitive behavioral therapy (CBT) is a form of therapy that helps you identify and change thought processes. Replacing negative thoughts with more positive ones can help you learn how to manage your symptoms.
• Interpersonal therapy can help you work on one or two problem areas, such as relationships with friends and family. Learning about the disorder and how to manage symptoms also helps.

Other treatments

Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and therapy.

Claims have been made that certain herbal and dietary products help control depression symptoms. Omega-3 fatty acids may help to reduce symptoms of depression. No known herbal or natural remedies are effective in treating cyclothymia. Supplements are not tested or standardized and may vary in strengths and effects. They may have side effects and are not always safe. Talk with your healthcare provider before you use any of these products.

How can I take care of myself?

• Take your medicine daily, even if you are feeling well. Stopping your medicine when you feel well may cause symptoms to return.
• Get support. Talk with family and friends. Consider joining a support group in your area.
• Watch yourself for the beginning signs of either a manic or depressive phase. Ask others around you to also watch closely. Keep track of your mood daily. This can help you and your healthcare provider understand your condition and find the best treatment.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, try to quit. Exercise according to your healthcare provider's instructions.
• Avoid alcohol and drugs, because they can make your symptoms worse.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

Get emergency care if you or a loved one have serious thoughts of suicide or harming others.

For more information, contact:

• National Institute of Mental Health
  866-615-6464
  http://www.nimh.nih.gov/
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/
• Depression and Bipolar Support Alliance
  800-826-3632
  http://www.dbsalliance.org