cyclothymia

Generality

Cyclothymia, or cyclothymic disorder, is a mood disorder, so those affected suffer alternating moments of moderate depression (depressive episodes) with moments of euphoria and excitement (manic episodes). It resembles bipolar disorder but is less severe than the latter.

The precise causes of cyclothymia are currently unknown. According to experts, a combination of hereditary, biochemical and environmental factors would play a key role.

For a precise diagnosis of cyclothymia, the physical examination, some laboratory tests and the evaluation of the psychological profile are fundamental.

The therapy, consisting of psychotherapy, mood stabilizing drugs and antidepressant drugs, aims to limit symptoms and possible complications.

What is cyclothymia?

Cyclothymia, or cyclothymic disorder, is a mood disorder characterized by emotional oscillations, ranging from moderate depression to a state of euphoria and excitement.

Due to the effects it causes, cyclothymia is very similar to bipolar disorder; compared to the latter, however, it is responsible for less intense symptoms. In fact, the associated depressive state is less severe (NB: in the case of bipolar disorder we speak of major depression), just as the feeling of euphoria and excitement is less severe.

Epidemiology

Cyclothymia is a very rare mood disorder. However, it is necessary to point out that the data relating to its diffusion are scarce and not very reliable, as it is a problem that often goes unnoticed or that is not the object of an accurate diagnosis.

The reasons for this lack of confirmation are probably linked to the fact that many cyclothymic patients are able to lead a normal life, without particular difficulties.

The incidence of cyclothymia in the two sexes is almost the same.

For reasons that are still unclear, cyclothymic disorder mainly affects young people and young adults.

ORIGIN OF THE NAME CICLOTIMIA

The word "cyclothymia" comes from the Greek word " kyklotimia " ( κυκλοθυμία ), fruit of the union between:

Kyklos ( κῦκλος ), which means "circle" or "circle", e
Thymos ( θυμός ), which means "mood".

The use of the word cyclothymia derives from the emotional oscillations that characterize the mood disorder in question.

Causes

At present, the precise causes of cyclothymia are a mystery.

According to the most reliable hypotheses, a combination of hereditary, biochemical and environmental factors would play a decisive role in the appearance of cyclothymic disorder.

HEREDITARY FACTORS

Studying a large number of clinical cases, the researchers noted that cyclothymia tends to recur within the same family: several patients, among those considered, had more or less distant relatives affected by the same mood disorder or bipolar disorder.

All this has led scholars to hypothesize that cyclothymic disorder may have, at least in some circumstances, a genetic-hereditary basis .

The idea that hereditary factors can affect hereditary factors on the appearance of cyclothymia is particularly interesting, but requires further study before it can be considered fully reliable.

BIOCHEMICAL FACTORS

According to some experiments, some alterations in the biochemical processes taking place in the brain would be crucial in the appearance of cyclothymia.

The theories in this regard are still full of question marks, which only future research can definitively clarify.

ENVIRONMENTAL FACTORS

Premise: an environmental factor is any circumstance, event or habit that can affect the life of an individual to a certain extent.

Doctors and experts in the field of mood disorders have observed that the past of cyclothymic patients often presents traumatic experiences (both emotionally and physically) or long periods of stress .

From this, they hypothesized that cyclothymia may be dependent on events from the past, experienced in a particularly intense and shocking way.

Symptoms and Complications

To learn more: Symptoms Cyclothymic disorder

Those who suffer from cyclothymia alternate manic episodes, characterized by euphoria and excitement, with depressive episodes, characterized by mild to moderate depression.

Therefore, the symptoms and signs of cyclothymia are extremely variable.

MANIACAL EPISODES: TYPICAL SYMPTOMS

During manic episodes, the subject with cyclothymia typically exhibits:

An exaggerated feeling of happiness and well-being (euphoria)
Extreme optimism
Extreme self-esteem
Extreme talkativeness (speaks more than normal)
Poor judgment, which can even lead him to perform dangerous gestures or risky choices for his own safety
Quick thinking
Agitated or irritable behaviors
A particular tendency to excessive physical activity
A particular desire to want to achieve certain results
Poor need for sleep
A particular tendency to distraction
A particular inability to concentrate properly

DEPRESSIVE EPISODES: TYPICAL SYMPTOMS

In general, they characterize the depressive episodes of the cyclotomy:

Sadness, hopelessness and a sense of emptiness
Cry
Irritability (especially in younger people)
Loss of interest in all those activities, which usually represent an enjoyable or popular pastime
Weight variations
Night sleep disorders
Sense of worthlessness or guilt
Restlessness
Sense of fatigue and slowness in doing things
Concentration problems
Suicidal thoughts

STABILITY PERIODS: ARE THERE?

It is wrong to think of cyclothymia as a continuous alternation of mood swings.

In fact, there are periods of humoral stability, in which the cyclothymic patient seems normal.

These periods of stability generally have a duration of less than two months.

WHEN TO REFER TO THE DOCTOR?

Anyone suffering from cyclothymia (or suspected of being affected) should immediately contact a specialized doctor or an expert in mental and mood disorders, to analyze the situation in detail and undergo appropriate treatment.

If you are a relative of a probably cyclothymic individual who does not realize you have problems, you should try to refer him to an expert or a specialized doctor.

COMPLICATIONS

In case of failure to treat, cyclothymia can have various complications.

The most important complications of cyclothymia include:

The onset of emotional problems that can affect the quality of life.
A particular tendency to develop so-called bipolar disorder.
The abuse of drugs or alcohol.
A particular tendency to develop anxiety disorders.

Diagnosis

For the purposes of a correct diagnosis of cyclothymia, the following are fundamental: an accurate physical examination, some laboratory tests, a careful evaluation of the psychological profile and, finally, the consultation of the so-called Diagnostic and Statistical Manual of Mental Disorders ( DSM ).

The DSM is a collection of all the peculiar characteristics of known mental and mental illnesses (including mood disorders), including the respective criteria required for diagnosis.

WHO IS THE DIAGNOSIS FOR?

Usually, the diagnosis of cyclothymia requires the involvement of a team of professionals, including general practitioners, psychiatrists and psychologists.

OBJECTIVE AND LABORATORY TEST

The physical examination and laboratory tests clarify whether the symptoms and signs present are related to some physical problem, rather than to cyclothymia.

Furthermore, they are excellent indicators of the patient's general health condition.

ASSESSMENT OF THE PSYCHOLOGICAL PROFILE

The evaluation of the psychological profile is up to a psychiatrist or a psychologist and consists of a discussion between one of these two professional figures and the patient.

The topic of the discussion is all that concerns the emotional and behavioral sphere of the patient, his thoughts and his feelings.

Furthermore, at the end of the discussion, a questionnaire is planned whose purpose is to investigate, again, the emotions, behavior, thoughts and feelings.

DIAGNOSIS ON THE BASIS OF DSM

According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, an individual suffers from cyclothymia if:

He has been experiencing manic episodes, alternating with depressive episodes, for at least two years, in the case of adults, or at least a year, in the case of children or adolescents.
The periods in which the mood is stable have a duration of less than two months.
Emotional fluctuations severely affect the social sphere (and therefore interpersonal relationships), the workplace, the school environment, etc.
The symptoms and signs found during the psychological evaluation do not coincide with those of bipolar disorder, major depression or another mood disorder (eg dysthymia).
Emotional fluctuations are not due to substance abuse or physical problems.

Treatment

Cyclothymia is a mood disorder that accompanies those affected by it for a lifetime.

However, with adequate treatment, it is possible to tangibly limit its symptoms and possible complications.

The therapy of cyclothymia is based on the use of psychotherapy techniques, sometimes associated with the administration of specific drugs against mood disorders and depression.

THERAPEUTIC OBJECTIVES

Briefly, the goals of the therapy provided in case of cyclothymia are:

Reduce the risk of the patient developing bipolar disorder. It should be remembered that cyclothymia is comparable to a less intense form of bipolar disorder, which can be a prelude to the latter.
Reduce the frequency and severity of symptoms and signs, which characterize manic episodes and depressive episodes.
This allows the patient to enjoy his life better.
Prevent possible relapses.
Treat any addictions to drugs or alcohol.

PSYCHOTHERAPY

The fundamental psychotherapy techniques for the treatment of cyclothymia include:

Cognitive behavioral therapy . This form of psychotherapy aims to teach the cyclothymic patient how to identify and dominate problematic behaviors (in specialized jargon, "inactive" or "distorted thoughts"), which characterize manic episodes and depressive episodes.
Moreover, it is of enormous help in identifying the so-called "triggers", ie the factors that trigger the symptomatology.
Cognitive-behavioral therapy includes a part "in the studio", with the psychotherapist, and a "home" part, reserved for the exercise and improvement of domain techniques.
Interpersonal therapy . This psychotherapy technique is based on the idea that interpersonal relationships and the external world in general have a decisive influence on a person's mental health.
According to those who practice interpersonal therapy, cyclothymia would originate from situations of emotional or physical stress, following a problematic relationship with other people, work, school, etc.
The therapeutic objective is to find out which interpersonal relationships have started the development of the mood disorder in question and, once this has been clarified, find a possible remedy.
Interpersonal therapy and social rhythms . This form of psychotherapy is a variant of previous interpersonal therapy.
In addition to the purposes of interpersonal therapy, it has the particular goal of stabilizing and adapting - based on the mood disorder in place - the patient's biological rhythms and sleep-wake rhythms.
The basic idea is that a regular daily routine is of enormous benefit to the mental health of the cyclothymic subject.

Other psychotherapy techniques adopted in case of cyclothymia:

Psychodynamic therapy
Group therapy
Dialectical-behavioral therapy

PHARMACOLOGICAL THERAPY FOR CYCLOTYMY

The FDA, that is the US government agency for the regulation of food and pharmaceutical products, believes that there are no specific drugs for the treatment of cyclothymia, therefore it has never approved its use.

However, based on what emerges from some clinical studies, cyclothymic patients would benefit from taking the same antidepressant and mood stabilizing drugs used for the treatment of bipolar disorder (NB: this is further confirmation of the existing link between the two psychic conditions).

The effect of these drugs would help to better control the symptoms of cyclothymia and to prevent manic episodes and depressive episodes.

Possible medicines for the treatment of cyclothymia and bipolar disorder
Mood stabilizing drugs	Antidepressant drugs
Lithium carbonate	Selective serotonin reuptake inhibitors (SSRIs)
Antiepileptics (lamotrigine, valproate or carbamazepine)	Tricyclic antidepressants
	Type A monoamine oxidase inhibitors (IMAO-A)
	Atypical antidepressants (eg: bupropion)

SOME MEDICAL ADVICE

In order for cyclothymic treatments to have better effects, doctors strongly recommend:

Undergo the treatment provided, without skipping any psychotherapy sessions or pharmacological administrations. Strictly following the therapeutic procedure is essential to avoid relapses; furthermore, it indicates that the patient is aware of his or her condition and the need to be treated.
Avoid drinking alcohol and using drugs. Alcohol and drugs induce mood swings and this can worsen the emotional fluctuations of cyclothymic.
Consult your doctor before taking any medicine. Some medications may interfere with medications taken to control cyclothymia.
Keep a journal in which to record the daily mood, the events that led to an emotional swing etc.
All this is of considerable help especially for the psychotherapist, when he is preparing to set up future psychotherapeutic sessions.
Do regular physical activity. Exercise has beneficial effects on mood, as it induces the release of endorphins, which are chemical substances linked to a particular sense of well-being and fulfillment.
Sleep the right number of hours and avoid "being late" in the evening. Regular nocturnal sleep plays a fundamental role in stabilizing mood.

Prognosis

If the treatments are adequate and the patient is scrupulous in following them, cyclothymia is a controllable mood disorder with a positive or, at least, non-negative prognosis.