Cyclothymic disorder is characterized by mood swings involving periods of hypomania (or elevated mood) and depressive symptoms. These symptoms are similar to those observed in patients with bipolar disorder but are less severe and more chronic. Individuals suffering from cyclothymic disorder may be more likely to eventually develop bipolar disorder, which makes early diagnosis and appropriate treatment of cyclothymic disorder essential.

There is no cure for cyclothymic disorder, and lifetime management of the symptoms is necessary. Treatment is essential even when symptoms are absent to avoid relapse. Generally, treatment for cyclothymic disorder involves psychotherapy and careful use of pharmacological drugs, but also requires lifestyle modifications and care for co-occurring mental health conditions, including addiction.

Medication

Cyclothymic disorder is a complicated disorder involving rapid changes in mood. Such extreme mood instability requires tailoring of treatment according to the emotional phase, and a slow and cautious approach is recommended.

Mood stabilizers, such as lithium and lamotrigine, can be moderately effective in preventing depressive states as well as hypomania. Lithium is particularly effective for treating cyclothymic disorder. Antipsychotics like quetiapine and anticonvulsant drugs can also be useful in the short-term treatment of cyclothymia symptoms, but long-term use should be avoided.

Antidepressants may be used when mood stabilizers fail to improve symptoms, but their use requires caution since treatment with such drugs may lead to a manic phase. Furthermore, the relatively well-known class of antidepressants (SSRIs- slow serotonin reuptake inhibitors) such as Zoloft and Prozac are not very effective in the treatment of cyclothymic disorders. However, a different class of antidepressants called tricyclic antidepressants have been found to be more effective.

Psychotherapy

Psychotherapy, also referred to as talk therapy, involves understanding the psychological basis of a medical disorder and changing the behavioral and thought patterns associated with it.

  • Cognitive Behavioral Therapy: Cognitive behavioral therapy (CBT) is a form of psychotherapy that involves recognizing negative patterns of thoughts and behaviors and developing coping skills to deal with those thoughts and behaviors. CBT, especially deployed along with mood stabilizers, has proven to be effective in the treatment of cyclothymic disorder symptoms.
  • Dialectical Behavioral Therapy: Dialectical behavioral therapy (DBT) is considered as a variant of CBT. Like CBT, DBT also focuses on coping with psychological problems through change, while also promoting acceptance of the past. Through DBT, people learn how to tolerate negative emotions and acquire interpersonal skills. DBT is considered to be particularly useful for treatment-resistant individuals suffering from cyclothymia.
  • Interpersonal and Social Rhythm Therapy: Individuals suffering from cyclothymia often show a disruption of biological rhythms, including sleep/wake cycles. Such disruptions are considered to be responsible, in part, for the cyclothymia symptoms. Interpersonal and social rhythm therapy (IPSRT) is a form of psychotherapy that helps cyclothymia patients establish a daily routine involving diet, exercise and sleep. Establishing daily routines may help stabilize biological rhythms, resulting in improved mood.  IPSRT also involves learning strategies to better identify and cope with social or interpersonal triggers.

Lifestyle Remedies

While clinical treatment is crucial to managing cyclothymic disorder symptoms, establishing healthy habits and a disciplined lifestyle can also significantly enhance well-being.

These lifestyle modifications should be undertaken after consulting a doctor to avoid any adverse effects:

  • Take medication as directed: The recommended therapeutic strategy for cyclothymic disorder involves a cautious approach with low doses of medications. This approach may lead to very gradual improvements and may result in discontinuation of treatment. However, continual use of medications may be necessary for mood stability in the long run. Furthermore, even after remission of symptoms, maintenance treatment involving mood stabilizers and psychotherapy is needed to avoid recurrence.
  • Avoid drugs or alcohol: Use of drugs or alcohol can exacerbate the symptoms of cyclothymic disorder. If someone with cyclothymic disorder is also living with addiction, co-occurring treatment for substance use disorder is essential for long-term management of symptoms.
  • Quit smoking: Smoking and nicotine can interfere with the mode of action of drugs used to treat cyclothymia, thus worsening its symptoms. Quitting smoking may present substantial challenges since individuals with cyclothymic disorder may smoke to cope with the symptoms of their condition. Mental health professionals may provide the necessary advice in such scenarios
  • Get plenty of sleep: Sleep disturbances and changes in the sleep/wake cycle are characteristic of mood disorders like cyclothymia. Getting adequate sleep and maintaining appropriate sleep/wake cycles can help improve mood and symptoms.
  • Exercise regularly: Exercise, yoga or other such physical activities may help alleviate cyclothymia symptoms by reducing stress. Physical activity is linked with positive mental health outcomes and may also help normalize sleep-wake cycles, which can improve symptoms.

Treating Cyclothymia and Co-occurring Disorders

Cyclothymic disorder is often studied together with other bipolar disorders as a bipolar spectrum disorder. Like other bipolar spectrum disorders, cyclothymia can co-occur with other conditions. For example, metabolic syndrome, a condition characterized by obesity and cardiovascular disorder, is more prevalent in bipolar spectrum individuals. Bipolar spectrum disorders, including cyclothymic disorder and substance use disorder also often occur together, which can exacerbate the symptoms of both conditions. Cyclothymic disorder can amplify the addictive qualities of these conditions, and substance abuse disorder may worsen symptoms of cyclothymic disorder.

In such cases, it is essential that cyclothymic and substance use disorder are treated simultaneously using the necessary pharmacological and psychotherapeutic interventions. If you or your loved ones are suffering from symptoms related to cyclothymic disorder and substance abuse disorder, please contact The Recovery Village. We provide help for co-occurring mental health and substance abuse disorders.