Cyclothymic disorder: symptoms, causes and treatment

The main feature of cyclothymic disorder is a chronic and fluctuating mood disturbance. We all know someone who we colloquially say often changes their mood, going from sadness to joy in a matter of a few days.

Well, these people could be suffering from a cyclothymic disorder, although not necessarily, of course. The mood of a person with cyclothymic disorder fluctuates between states of exaggerated “happiness” and depressive states. That is to say, There is a marked change in mood that most people would not consider “normal.”
It is important to distinguish cyclothymic disorder from bipolar disorder. Bipolar disorder is more serious, since its symptoms are more severe. In cyclothymic disorder, the criteria for a major depressive, manic, or hypomanic episode are never met, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

What criteria must be met to diagnose a cyclothymic disorder?

According to the DSM-V, the diagnostic criteria are as follows:
A. Presence, for at least 2 years, of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode.

Note: In children and adolescents the duration must be at least 1 year.

B. During the period of more than 2 years (1 year in children and adolescents) the person has not stopped presenting the symptoms of criterion A for a period of more than 2 months.

C. During the first 2 years of the disorder, no major depressive episode, manic episode or mixed episode has occurred.

Note: After the initial 2 years of cyclothymic disorder (1 year in children and adolescents), there may be manic or mixed episodes superimposed on the cyclothymic disorder (in which case both cyclothymic and bipolar I disorders are diagnosed) or episodes major depressives (in which case both disorders, cyclothymic and bipolar II disorder, are diagnosed).

D. The symptoms of criterion A are not better explained by the presence of a schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.

E. The symptoms are not due to the direct physiological effects of the administration or consumption of a substance (eg, a drug, medication) or a medical illness (eg, hyperthyroidism).

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of the individual’s functioning.

Diagnostic features

As we said at the beginning, cyclothymic disorder involves a chronic and fluctuating mood disorder. It involves numerous periods of hypomanic symptoms and periods of depressive symptoms, differentiated from each other. Hypomania is a term that defines elevated moods that do not become manic, but do cause symptoms of irritability and mild compulsive attitudes.

The symptoms of hypomania go unnoticed most of the timefirst because the patient himself feels stable (he even believes he is having a “great day” and is “in possession of reason” in front of others) and second, because it does not always cause a significant deterioration in his work, family or social environment. .

For greater difficulty in detection, Hypomania is sometimes confused with simple “joy” or slight occasional hyperactivity.. Mania, for its part, is defined as opposite to depression. The patient appears euphoric and elated, with excessive humor.

Besides, In cyclothymic disorder, depressive symptoms are insufficient in number, severity, generalization, or duration. to meet the criteria for a major depressive episode. The diagnosis of cyclothymic disorder is made only if the criteria for a major depressive, manic, or hypomanic episode are not met. This is very important, as it is what distinguishes it from bipolar disorder.

Development and course of cyclothymic disorder

Cyclothymic disorder usually begins in adolescence or early adulthood.. It is sometimes considered to reflect a temperamental predisposition toward other bipolar disorders. The onset of cyclothymic disorder is usually gradual, and the course is persistent. There is a 15-50% risk that a patient with cyclothymic disorder will later develop bipolar disorder.

If the onset of hypomanic or depressive symptoms occurs in late adulthood, it will need to be clearly distinguished from bipolar disorder and related disorders due to another medical condition (e.g., multiple sclerosis) before diagnosing it as cyclothymic disorder. .

In children with cyclothymic disorder, the average age of onset is 6 and a half years. As we have seen, Cyclothymic disorder is something like the little brother of bipolar disorder. There is a marked change in mood, which is not considered normal but is not as drastic as in bipolar disorder.

Bibliographic references

American Psychiatry Association (2014). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th Ed. Madrid: Editorial Médica Panamericana.

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