What is cyclothymia?

Understanding cyclothymia: A challenge for family and friends

Definition and differential diagnosis

It is a mood disorder characterized by a fluctuation between periods of hypomanic symptoms and periods of depressive symptoms, which do not meet the criteria to be diagnosed as a major depressive episode. The fluctuation is rapid; mood changes can occur within hours or from one day to the next. These symptoms must persist for more than two years, and there must not be a symptom-free period of more than two months.

We should not confuse cyclothymia with Bipolar Disorder. Bipolar disorder, as I will describe in another article, is a more serious disorder characterized by the presence of at least one manic episode or mixed episode (bipolar disorder I), or by the presence of at least one major depressive episode and one hypomanic episode (bipolar disorder II).

Cyclothymia is the least serious of the three, but even so, it greatly affects the daily life of the person who suffers from it and their environment. Making a good diagnosis is not easy; we must rule out other disorders that can be confused, due to their symptoms, with cyclothymia, such as borderline personality disorder. In it we also find mood fluctuations and instability in interpersonal relationships (love-hate relationships). But there are two differences that I always look at to make the differential diagnosis: the sleep pattern and the need for attention of the person with borderline disorder. As for sleep, although it also tends to vary in borderline disorder, when the person sleeps little they report being tired. In cyclothymia, even if they sleep little, they will be full of vitality and energy. The other trait is the need for attention that leads the person with borderline disorder to do anything to avoid an abandonment, whether real or not.

Symptoms of cyclothymia

Let's look in more detail at the symptoms of cyclothymia:

Hypomanic symptoms:

• The mood may be euphoric, expansive, or irritable
• There is an increase in self-esteem or grandiosity
• Decreased need for sleep (4 hours is enough and they feel rested)
• Increased energy or vitality
• More talkative than usual or verbose
• Flight of ideas or subjective experience that thinking is accelerated
• Lack of concentration and distractibility (easily distracted by trivial stimuli)
• Increased sociability
• Greater sexual desire
• Squandering money
• Drug abuse, especially cocaine and alcohol
• Increase in pleasurable activities that have a high potential to produce serious consequences (uncontrollable shopping, reckless financial investments, impossible business ventures, risky sexual behaviors,…)
• Increased talkativeness and wit.
• Provocative and intrusive behavior.

Depressive symptoms

• The mood is sad
• Low self-esteem
• Increased need for sleep
• Decreased energy and vitality
• Mental and physical fatigue
• Difficulty concentrating or making decisions
• Feelings of hopelessness
• Loss or increase of appetite
• Lower sexual desire

Impact on relationships and daily life

Due to these symptoms, and especially their fluctuation, it is very common for affected people to experience serious problems in their relationships with partners, family, and work.

The small events of everyday life generate large internal changes and, sometimes, without there being a previous trigger that apparently justifies this type of change.

When this happens so abruptly, unexpectedly, without understanding that there is a previous stimulus causing these changes, total bewilderment is generated in the people who live with them. In the end, they don't know what kind of behavior is appropriate, since it gives the impression that any small comment made can trigger an enormous crisis in the other person. You never know how they are going to react.

Causes:

Cyclothymic disorder does not seem to obey a single cause and affects men and women equally. On the one hand there is the hereditary factor, a fact verified through extensive studies carried out on twins, both dizygotic and monozygotic, which confirms the genetic element as one of the causes involved in the development of this illness. On the other hand, certain psychological and social aspects must also be considered, such as some life events, traumatic facts, or certain living conditions.

What is clear is that Cyclothymia is due to biological changes in the nervous system.

Treatment of cyclothymia:

Fortunately, the treatment is highly effective in reducing symptoms and helping the patient improve their health and lead a full life. The problem with the treatment of cyclothymia is that the patient rarely goes to the psychologist. Being a disorder that does not incapacitate the person, at least not like bipolar disorder, the person who suffers from it can lead a more or less normal life, and although they are aware that they have difficulties in many areas of their daily life, they do not ask for help until there is an important event that aggravates the symptoms (death of a family member, romantic breakup, drug abuse,…)

Psychological treatment is effective. In some cases, it must be combined with pharmacological treatment, with euthymizers or mood stabilizers being the ones that work best:

• Lithium. Lithium has been used for years in patients with bipolar disorder and can help patients with cyclothymic disorder. The only problem with lithium is its toxicity. The patient must have monthly blood tests to monitor its level in the blood.

• Anticonvulsant drugs. Valproic acid (Depakote), carbamazepine (Tegretol), oxcarbazepine (Trileptal), and lamotrigine (Lamictal) are the most recognized mood-stabilizing anticonvulsants.

As for psychological therapy, as a general rule, it should pursue two objectives:

• Improving interpersonal relationships and
• Creating healthy routines

Relationships can be a significant source of stress for people with Cyclothymia and can contribute to changes in their moods. This therapy is similar to family or couples therapy, since it helps individuals learn better communication skills and resolve their problems, and it also helps their loved ones understand that cyclothymia is a neurochemical disorder and is not the person's fault.

According to Preston: "Routine is the key to stabilizing moods, and people with cyclothymic disorder are especially sensitive to change. Any modification in their eating, sleeping, or exercise patterns can interfere with their circadian rhythms and can trigger an episode".

We must take special care with the abuse of substances such as alcohol or drugs, since they can trigger the onset of an episode.

The treatment of cyclothymia is effective and greatly helps the person to live a fuller life without suffering.

Now when they ask you what is cyclothymia?, you can surely give an answer.