Cyclothymic disorder is characterized by hypomanic and depressive symptoms, which are less severe than those in bipolar disorder and follow an irregular course; symptoms occur on more than half the days during a period of ≥ 2 years. Diagnosis is based on standard psychiatric criteria. Management consists primarily of education, although some patients with functional impairment require medications.
Cyclothymic disorder involves hypomanic and depressive periods in patients who never fulfill the criteria for an episode of mania, hypomania, or major depression. It is commonly a precursor of bipolar I disorder or bipolar II disorder. However, it can also occur without developing into a major mood disorder.
In chronic hypomania a form rarely seen clinically, elated periods predominate, with habitual reduction of sleep to < 6 hours. People with this form are constantly overcheerful, self-assured, overenergetic, full of plans, improvident, overinvolved, and meddlesome; they rush off with restless impulses and may act in an overly familiar manner with people.
Some people, function well during periods of hypomania; however, over the course of the disorder, mood disturbances and fluctuations may have serious detrimental interpersonal and social consequences. Consequences may include instability with an uneven work and schooling history, impulsive and frequent changes of residence, repeated romantic or marital breakups, or episodic abuse of alcohol and drugs.
Lifetime prevalence of cyclothymic disorder is estimated at <1% to 2.5% (1). It appears to occur at similar rates in women and men.
(See also Overview of Mood Disorders.)
General reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision. American Psychiatric Association Publishing; 2022.
Diagnosis of Cyclothymic Disorder
Diagnosis of cyclothymic disorder is based on the following diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision. Symptoms must have been present for at least 2 years, or 1 year in children and adolescents, and impair functioning and include the following (1):
Numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode
Symptoms have been present for at least half of the 2-year period (1 year in children and adolescents), and the individual has not been without symptoms for more than 2 months at a time
Also, the symptoms are not attributable to bipolar I or bipolar II disorder, to another psychiatric disorder (eg, schizoaffective disorder, delusional disorder), to the psychological effects of a substance, or to another medical condition (eg, hyperthyroidism).
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision. American Psychiatric Association Publishing; 2022.
Treatment of Cyclothymic Disorder
Psychoeducation and supportive care
Sometimes a mood stabilizer
Patients should be taught how to live with the extremes of their temperamental inclinations; however, living with cyclothymic disorder is not easy because interpersonal relationships are often stormy. Jobs with flexible hours are advised. Patients might be encouraged to pursue careers that are compatible with the excesses and emotional fragility of cyclothymia.
The decision to use a mood stabilizer (eg, lithium; certain antiseizure medications, especially valproate, carbamazepine, and lamotrigine) depends on the balance between functional impairment and the social benefits or creative spurts that patients may experience (, especially valproate, carbamazepine, and lamotrigine) depends on the balance between functional impairment and the social benefits or creative spurts that patients may experience (1). Evidence for efficacy is anecdotal and the doses used are generally lower than those used for bipolar disorder (1).
Antidepressants are generally reserved for severe and prolonged depressive symptoms, and patients should be monitored closely because switching and rapid cycling are risks (1).
Support groups can help patients by providing a forum to share their common experiences and feelings.
Treatment reference
1. Perugi G, Hantouche E, Vannucchi G. Diagnosis and Treatment of Cyclothymia: The "Primacy" of Temperament. Curr Neuropharmacol. 2017;15(3):372-379. doi:10.2174/1570159X14666160616120157
