Cyclothymic Disorder

With this chronic, fluctuating mood disturbance the patient fluctuates between being hypomanic and being depressive. This condition must exist at least for 2 years in adults or for 1 year in children and teenagers, before the diagnosis of cyclothymic disorder can be made and no depressive disorder or manic disorder is occurring in that period of time (otherwise this would change the diagnosis). The hypomanic symptoms will often not be noticed by the patient, as they are being perceived as normal.

The depressed feelings are as listed below under dysthymic disorder. Relatives, friends and loved ones around these patients perceive them as inconsistent, temperamental, unreliable or moody. They may get into relationship problems as their mates may find them too unpredictable and difficult to live with. The patient with a cyclothymic personality is more likely to impulsively change residence, schools and work places. There may also be episodes of drug and alcohol abuse.

The course of cyclothymic disorder starts usually in adolescence or in early adulthood. If it only starts later in adult life, there is a strong possibility that there may be a medical condition such as multiple sclerosis that is responsible for this mood disorder. Cyclothymic disorder usually has a chronic lifelong course, and there is a risk of about 30% that the patient will develop bipolar I or II disorder subsequently.

Treatment:

Patients and their partners need to be taught to live with their problem. Supportive counseling and reading self help books about their disorder will help them to understand their illness.

If they can get employment with an employer who allows flex hours, it will help to stabilize the employment situation to a certain extend. If a patient has artistic inclinations, this should be supported as in these circles a cyclothymic personality is better tolerated. Occasionally there may be some place for a mood stabilizer such as divalproex, which is another name for valproic acid. (brand names: Epival, Depakote). Side-effects can include liver damage in the first 6 months of treatment. Sometimes an artistically inclined person may refuse medication as the hypomanic mood swing is desired when the person is most creative and productive.

Mental Health Organizer

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Dr. David Burns: "Feeling good --The new mood therapy", Avon Books, New York,1992.

2. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV),American Psychiatric Association, Washington,DC,1994.

3. Dr. Shaila Misri at the 46th St. Paul's Hosp. Cont. Educ. Conference, November 2000, Vancouver/B.C./ Canada.

4. JM Loftis et al. J Neurochem 2000 Nov 75(5): 2040-2050.

5. B. Zilbergeld et al. "Hypnosis - Questions& Answers", W.W. Norton & Co, New York,1986: 307-312.

6. MH Erickson & EL Rossi:"Hypnotherapy, an exploratory casebook", Irvington Publishers Inc., New York, 1979: chapter 8, 314-363.

7. G Steketee et al. Compr Psychiatry 2001 Jan 42(1): 76-86.

8. DS Mennin et al. J Anxiety Disord 2000 July-Aug 14(4): 325- 343.

9. J Hartland: "Medical &Dental Hypnosis and its Clinical Applications", 2nd edition, Bailliere Tindall,London,1982, page: 326-336.

Last Modified: Jan. 13, 2007