Medicines for Cyclothymia

What it is

Cyclothymia (cyclothymic disorder) is a mood condition in which a person experiences ongoing mood swings — periods of feeling low (mildly depressed) alternating with periods of feeling elated, energetic, or "high" (mild highs) — that are milder than those of bipolar disorder, but are persistent over a long time. It is considered a milder, chronic form of mood instability, related to (but less severe than) bipolar disorder. The mood changes in cyclothymia are less extreme than the full episodes of depression and mania seen in bipolar disorder, so a person may not seem obviously unwell, but the ups and downs are frequent and long-lasting, and can affect daily life, relationships, work, and wellbeing. During the low periods, a person may feel down, tired, less motivated, and have some of the milder features of depression; during the high periods, they may feel unusually cheerful, energetic, confident, talkative, or need less sleep, and may be more impulsive. The mood changes can be unpredictable, and the person may have relatively stable periods in between. Because the symptoms are milder, cyclothymia can go unrecognised or be dismissed as just being "moody", but it is a recognised condition that is persistent and can be distressing and disruptive, and it is worth recognising and treating. There is also a chance that cyclothymia can, in some people, develop into bipolar disorder over time, which is another reason it is worth being aware of and managing. Cyclothymia is treatable and manageable: talking therapies (such as cognitive behavioural therapy) can help people understand and manage their mood, self-management strategies (such as monitoring mood, routine, and lifestyle measures) help, and, in some cases, medication (such as mood-stabilising medicines) may be used, guided by a doctor. Support from a GP or mental health services helps. The key messages are that cyclothymia is a mood condition with milder but persistent ups and downs (less severe than bipolar disorder), that it is worth recognising and treating, and that talking therapies, support, self-management, and sometimes medication help.

How it is treated

Cyclothymia is managed with talking therapies, self-management strategies, support, and, in some cases, medication, to help the person manage their mood and reduce the impact of the ups and downs; it is worth seeking help, as the condition is persistent. Because the mood changes are milder, cyclothymia can go unrecognised, so an important step is recognising it and seeking help — a GP can assess the mood pattern, consider the diagnosis (distinguishing it from other mood conditions, including bipolar disorder), and arrange support. Talking therapies are helpful: cognitive behavioural therapy (CBT) and other psychological approaches can help a person understand their mood patterns, develop strategies to manage the highs and lows, address unhelpful thoughts and behaviours, and cope with the impact on their life. Self-management is also important, and can include: monitoring or keeping track of mood (which helps recognise patterns and early changes); maintaining a stable routine (including regular sleep, which is important for mood stability); lifestyle measures that support mood (such as regular activity, a balanced approach to work and rest, and managing stress); reducing things that can destabilise mood (such as alcohol and recreational drugs); and having a plan for managing low or high periods. Support from a GP, mental health services, and, where relevant, support organisations helps, and involving trusted people can provide support. In some cases, medication may be used — for example, mood-stabilising medicines (as used in bipolar disorder) may be considered for some people, guided by a doctor or specialist, particularly if the mood swings are more troublesome; and treatment for any associated depression is given carefully (as, in mood conditions related to bipolar disorder, some antidepressants can occasionally affect mood stability, so medication is guided by a doctor). Because cyclothymia can, in some people, develop into bipolar disorder, ongoing awareness and support are worthwhile, and it is important to seek help if the mood changes become more severe. It is important to seek help promptly if there are ever thoughts of self-harm or suicide. The reassuring messages are that cyclothymia is a recognised, treatable condition, that talking therapies, self-management (such as monitoring mood, routine, and lifestyle measures), support, and sometimes medication help people manage their mood and reduce the impact of the ups and downs, and that recognising it and seeking help are worthwhile; so seeing a GP for persistent mood swings, accessing talking therapy and support, and self-management are the keys to managing cyclothymia.