Cyclothymia: When your mood is always on a rollercoaster

What is cyclothymia?

Defining cyclothymic disorder

Cyclothymia, also known as cyclothymic disorder, is a long-term mood condition marked by frequent changes in emotional state. These recurrent shifts alternate between mild depressive symptoms and periods of elevated mood known as hypomania. While these mood swings are noticeable, they are not as extreme or disabling as those seen in bipolar I or II disorders. Despite this, the fluctuations are persistent and can have a lasting effect on a person’s mental health, relationships, and ability to function in daily life. Because the symptoms do not always seem severe, they can easily be dismissed or misinterpreted, making cyclothymia one of the more underdiagnosed mood disorders.

Differences between cyclothymia and bipolar disorder

Although cyclothymia is part of the broader bipolar spectrum, it is different in terms of severity. In bipolar disorder, individuals experience intense manic or depressive episodes that can significantly interfere with daily life. In contrast, people with cyclothymia experience more subtle mood changes, which occur frequently and can feel destabilising even if they do not meet the clinical criteria for full mania or major depression. These shifts can happen within days or even hours, and individuals often do not return to a stable baseline in between. Because these changes are less pronounced, they are often seen as moodiness rather than a mental health condition, which makes diagnosis more complicated.

How common is cyclothymia?

Cyclothymia is believed to affect around 2 to 5% of the population, although experts suspect the actual number may be higher due to how often the condition goes undiagnosed. It commonly emerges during adolescence or early adulthood, but it can also develop later in life. Both men and women are affected in roughly equal numbers, although the way symptoms present can differ slightly between genders. The condition often goes unrecognised because its symptoms are mistaken for personality traits or are overshadowed by other mental health issues like anxiety or depression.

What are the symptoms of cyclothymia?

Understanding hypomanic episodes

During hypomanic phases, a person might feel unusually energetic, optimistic, or confident. They may find themselves speaking more rapidly, sleeping less, and feeling driven to take on new tasks or projects. Creativity and productivity might increase, and there can be a sense of euphoria or invincibility. However, this heightened state may also include irritability, restlessness, and impulsive decision-making, such as spending large sums of money or making hasty life changes. These periods can feel exhilarating but may have consequences the individual doesn’t fully recognise until later.

Recognising mild depressive episodes

When the mood shifts downward, a person may experience a general sense of sadness, reduced energy, and difficulty concentrating. Daily tasks might feel harder to manage, and the person may become withdrawn or disinterested in social or recreational activities. Unlike major depressive episodes, these low periods might not last as long or be as intense, but they can still have a significant impact on motivation and self-worth. Fatigue and a feeling of emotional numbness or emptiness are also common during these times.

The challenge of ongoing emotional instability

One of the most defining aspects of cyclothymia is the continuous emotional instability. A person might feel like their mood is constantly shifting without clear cause, leading to confusion and frustration. This instability can interfere with relationships and make it difficult to maintain a steady routine at work, school, or home. People often describe feeling as though they are emotionally “out of sync” and struggle to make sense of their own reactions, leading to increased stress and sometimes even self-doubt.

What causes cyclothymia?

Genetic and biological factors

There is evidence to suggest that cyclothymia runs in families. People who have a close relative with bipolar disorder or another mood disorder are more likely to develop cyclothymia themselves. Researchers believe that certain genes involved in regulating brain chemicals like dopamine and serotonin may increase vulnerability to mood instability. These neurotransmitters are essential for maintaining emotional balance, and irregularities in their functioning can contribute to the development of mood disorders.

Environmental influences and early life experiences

Environmental stressors, particularly during early life, can also play a major role. Experiences such as emotional neglect, family conflict, trauma, or loss can increase the likelihood of developing cyclothymia. The way a person copes with stress and navigates emotional relationships during childhood and adolescence may shape how their mood patterns develop later in life. Even in adulthood, ongoing stress from work, family responsibilities, or social pressures can exacerbate mood fluctuations in those who are predisposed.

Psychological and situational triggers

Certain life events can act as triggers for the onset or worsening of cyclothymic symptoms. Events such as a breakup, bereavement, or job loss may bring about noticeable changes in mood patterns. From a biological standpoint, changes in the way the brain processes emotions, particularly in areas involved in impulse control and emotional regulation, are believed to contribute to cyclothymia. Hormonal imbalances and an overactive response to stress may also be involved, making it more difficult for someone to maintain a stable mood over time.

How is cyclothymia diagnosed?

The role of mental health professionals

Only a qualified mental health professional, typically a psychiatrist, can diagnose cyclothymia. Diagnosis involves a thorough clinical interview, a detailed review of mood history, and a careful observation of patterns over time. The specialist must also distinguish cyclothymia from other psychological conditions, such as personality disorders or anxiety disorders, which can have overlapping symptoms. This process is crucial for ensuring that the individual receives the correct diagnosis and appropriate support.

Diagnostic criteria according to the DSM-5

The current diagnostic criteria for cyclothymia, as outlined in the DSM-5, require the presence of recurring symptoms of hypomania and mild depression over a period of at least two years in adults, or one year in adolescents. Importantly, these symptoms must not meet the full criteria for a diagnosis of bipolar I or II disorder. The mood shifts must not be better explained by another mental health condition or the use of substances, and they must cause significant distress or impairment in daily functioning, particularly in social or professional settings.

Are there tests that can detect it?

There are no blood tests or brain scans that can definitively diagnose cyclothymia. However, screening tools such as the Mood Disorder Questionnaire (MDQ) can be used as a starting point. These tools allow individuals to reflect on their mood patterns and may help clinicians identify potential signs of a mood disorder. Although they are useful, such questionnaires are not substitutes for a comprehensive evaluation by a mental health specialist.

What are the treatment options?

Psychotherapy as the foundation of care

Psychological therapy is considered the most effective first-line treatment for cyclothymia. Cognitive behavioural therapy (CBT) is particularly beneficial, as it helps individuals identify distorted thought patterns, understand their emotional cycles, and develop healthier coping strategies. Other therapeutic approaches, such as interpersonal therapy, mindfulness-based therapy, and emotion regulation training, can also be useful in teaching individuals how to manage mood changes and respond more effectively to stress.

Considering medication when necessary

In cases where mood fluctuations are especially frequent or disruptive, medication may be recommended. Mood stabilisers such as lithium or lamotrigine are sometimes prescribed to help reduce the intensity and frequency of mood swings. Antidepressants can be used in some cases but must be approached cautiously, as they can occasionally trigger hypomanic symptoms if not balanced with a mood stabiliser. The decision to use medication should always be based on an individualised treatment plan created in partnership with a healthcare provider.

The importance of consistent follow-up and routine

Regular follow-up with a psychiatrist or therapist plays a vital role in long-term management. Treatment plans may need to be adjusted over time based on changes in symptoms or life circumstances. Equally important is establishing a stable daily routine. Maintaining a consistent sleep schedule, eating well-balanced meals, exercising regularly, and finding time for stress-reducing activities like meditation or hobbies can all help minimise mood instability.

Living with cyclothymia: Practical advice

Managing daily life with emotional awareness

Living well with cyclothymia starts with understanding your own emotional rhythms. Tracking mood changes through journals or apps can be helpful in recognising patterns and early warning signs. Establishing a predictable daily routine and avoiding overstimulation, such as excess caffeine or late-night screen time, can also support emotional balance. Developing self-awareness and being proactive in your self-care can make a significant difference in managing the condition.

Navigating professional life with cyclothymia

The workplace can pose unique challenges for individuals with cyclothymia, including difficulties with focus, managing stress, or maintaining consistent energy levels. Being open with trusted colleagues or supervisors, when appropriate, may lead to a more supportive environment. Seeking input from an occupational health advisor can help identify helpful accommodations, such as flexible working hours or modifications to workload, that make day-to-day responsibilities more manageable.

Talking to loved ones about the condition

Opening up about cyclothymia can feel daunting, especially when worried about being misunderstood or judged. However, sharing information about the condition with family and close friends can improve communication and foster more supportive relationships. Loved ones can also play an important role in helping to identify changes in mood and encouraging the individual to seek help when needed. Creating a network of understanding people around you can be one of the most powerful tools for staying emotionally balanced.

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