Cyclothymia, also known as Bipolar disorder type 3, is a mood disorder, and a relative of the widely recognized bipolar disorder. It’s often misunderstood or misdiagnosed as clinical depression and not readily distinguished from Bipolar 1 and 2. Cyclothymia causes disruptive, involuntary mood swings as in bipolar 1 and 2. However, the main differentiator is the manic highs in Cyclothymia are not as severe as in Bipolar 1, and the depressive state is milder than in Bipolar 2. And, between these opposing states, there is stability and a sense of calm. (1) While Cyclothymia does not have the notoriety of bipolar 1 or 2, it is a serious illness that can fracture relationships and work. It is regrettably referenced as ‘bipolar lite’, a cavalier nomenclature for an illness that can cause severe impairment.
According to the Diagnostic and Statistical Manual, 4th Edition, the criteria for Cyclothymia are framed by the duration of the mood swings, and it’s impact on daily life. It can be diagnosed if you’ve had numerous periods of hypomania and many depressive episodes for at least 2 years. And your periods of stable moods usually last less than 2 months, and negatively impact your ability to socialize, work and learn. Additionally there is no other mental illness that is responsible for these mood swings, and these symptoms are not the result of drugs, alcohol or a medical condition. (2)
One of the challenges for individuals with Cyclothymia is the ability to identify hypomania. In the hypomanic phase, individuals often experience a sense of euphoria. Not surprisingly, few people find reason to complain about feeling invincible, energized and hyper productive. These emotional highs may also include feelings of inflated self worth, rapid speech and racing thoughts, decreased need for sleep, poor judgment, increased sex drive, aggression and hostility, impulsive decision making, lack of concentration, and irritability. Yet the peril of mania occurs when the inflated sense of self leads to reckless choices and irresponsible behavior, with little regard for consequences. This is where family members and close friends can provide critical support; that is they can help identify the non-normative behavior, and help round out the narrative. As one client stated, ‘it wasn’t till my son pointed out that staying up till 3 in the morning to cut out over 100 coupons was unusual…not to mention the 4 broken laptops I had purchased in 10 days that were in our kitchen awaiting my doctoring.…at the time, I felt energized and even gifted…like there wasn’t a problem I couldn’t solve.’
Clients that are struggling with the dark or depressive phase of Cyclothymia are far more likely to seek treatment. The depressive symptoms include feelings of hopelessness, anxiety, sleep and appetite problems, decreased sex drive, fatigue, loss of interest in activities of enjoyment, irritability, and suicidal thoughts or behaviors. The critical goal for clinicians is to carefully uncover an accurate history of all recent events, feelings and behaviors, and perhaps even educate clients about what mania may look like. Rushing to classify someone as unipolar or clinically depressed without assessing for mood shifts can cause further duress. Furthermore, studies found that Cyclothymic patients treated with SSRI anti-depressants alone had the risk for increased mania. (3)
Treatment and education is critical for those with Cyclothymia and their families. This illness can present many challenges for individuals who may feel paralyzed by a lack of control over the timing, duration or severity of their mood swings. They may have difficulty trusting their everyday moods from a manic or depressive phase, and lack confidence in making decisions. And, since there is far less information about Cyclothymia there is the danger of clients and families dismissing grandiose and irrational behavior as personality quirks, and only seek treatment for depressed mood. Engagement with a skilled therapist who can provide support and education about polarity, and work on meeting realistic client goals is highly recommended. Treatment options for Cyclothymia include talk therapy, medication (including mood stabilizers and anti-depressants) and close monitoring by your physician.