Mood disorder that is a less severe but more chronic form of bipolar disorder

Bipolar disorder is a class of mood disorders that is marked by dramatic changes in mood, energy and behaviour. The key characteristic is that people with bipolar disorder alternate between episodes of mania (extreme elevated mood) and depression (extreme sadness). These episodes can last from hours to months. The mood disturbances are severe enough to cause marked impairment in the person’s functioning.The experience of mania is not pleasant and can be very frightening to the person. It can lead to impulsive behaviour that has serious consequences for the person and their family. A depressive episode makes it difficult or impossible for a person to function in their daily life.

People with bipolar disorder vary in how often they experience an episode of either mania or depression. Mood changes with bipolar disorder typically occur gradually. For some individuals there may be periods of wellness between the different mood episodes. Some people may also experience multiple episodes within a 12 month period, a week, or even a single day (referred to as “rapid cycling”). The severity of the mood can also range from mild to severe.

Establishing the particular type of bipolar disorder can greatly aid in determining the best type of treatment to manage the symptoms.

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Types of bipolar disorder

The different types of bipolar disorder are based on the severity and duration of the altered mood.

• Bipolar I disorder is characterized by at least one manic episodes or mixed episodes and one or more major depressive episodes. These episodes last for at least one week but may continue for months. Bipolar I disorder is the most severe form of the illness.

• Bipolar II disorder is characterized by predominantly depressive episodes accompanied by occasional hypomanic episodes. Hypomanic episodes are milder than manic episodes but can still impair functioning. Between episodes, there may be periods of normal functioning. The risk of suicide is high for this type of bipolar disorder.

• Cyclothymic disorder is characterized by chronic fluctuating moods involving periods of hypomania and depression. The periods of both depressive and hypomanic symptoms are shorter, less severe, and are separated by periods of normal mood. However, these mood swings can impair a person’s life and create chaos as they can be feeling on top of the world one day and feeling down and depressed the next day. Some people with cyclothymia develop a more severe form of bipolar illness while for others, it continues as a chronic (ongoing) condition.

• Bipolar Disorder Not Otherwise Specified: Some people will experience the symptoms of a manic episode and a major depressive episode, but their symptoms do not fit into the above mentioned types of bipolar disorder. This is known as Bipolar Disorder Not Otherwise Specified. For example,a person who experiences rapid cycling between manic and depressive episodes would be diagnosed with this type of bipolar disorder. Just like the other types of bipolar disorder,Bipolar Disorder Not Otherwise Specified is a treatable disorder.

• Mixed episodes are ones in which a person simultaneously experiences characteristics of both mania and depression. For example, a person may experience excitability and agitation of mania coupled with depression and irritability. This combination of energy, agitation and depression makes a mixed episode the most dangerous for risk of suicide.

The DSM

• The Diagnostic Statistical Manual (DSM-IV-TR) is a manual used by doctors to determine the specific type of bipolar disorder. The diagnosis is based on the severity of symptoms and length of time that the symptoms are evident.

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Managing bipolar disorder

People with bipolar disorder can lead healthy and fulfilling lives when the illness is effectively treated and managed.

Without treatment, the illness tends to worsen. Over time a person may suffer more frequent and more intense episodes. Treatment can help to reduce frequency and severity of episodes and help to maintain a good quality of life.

About the author

The Mood Disorders Association of BC is dedicated to providing support, education, and hope for recovery for those living with a mood disorder or other mental illness. For more, visit www.mdabc.net or call 1-604-873-0103.

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What Is Cyclothymia?

Cyclothymia, or cyclothymic disorder, is a mild mood disorder with symptoms similar to bipolar II disorder. Both cyclothymia and bipolar disorder cause emotional ups and downs, from manic highs to depressive lows.

Cyclothymia is characterized by fluctuating low-level depressive symptoms along with periods of mild mania (hypomania). Symptoms must be present for at least two years before a diagnosis of cyclothymia may be made (one year in children). These changes in mood tend to occur in cycles, reaching highs and lows. In between these highs and lows, you may feel like your mood is stable.

The main difference between the two disorders is intensity. The mood swings associated with cyclothymia are not as extreme as those that come with bipolar disorder: Those with bipolar disorder experience intense symptoms that meet clinically criteria for the diagnoses of mania and major depression, while those with cyclothymia experience milder “ups and down,” described as hypomania and mild depression. If left untreated, cyclothymia can increase your risk of developing bipolar disorder.

The condition usually develops in adolescence. People with the disorder often appear to function normally, although they may seem “moody” or “difficult” to others. People will often not seek treatment because the mood swings do not seem severe. People with cyclothymia may occasionally even be hyper-productive.

According to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-V), cyclothymia is distinguished from bipolar disorder because it lacks the full criteria of major depression, mania, or a mixed episode disorder. However, some people with cyclothymia will develop bipolar I or bipolar II disorder later in life.

People with cyclothymia usually experience many weeks of low-level depression followed by an episode of mild mania that lasts several days.

Depressive symptoms of cyclothymia may include:

• irritability
• aggressiveness
• insomnia or hypersomnia (sleeping too much)
• changes in appetite
• weight loss or gain
• fatigue or low energy
• low sexual desire and function
• feelings of hopelessness, worthlessness, or guilt
• inattentiveness, lack of concentration, or forgetfulness
• unexplained physical symptoms

The manic symptoms of cyclothymia may include:

• extremely high self-esteem
• excessive talking or speaking very quickly, sometimes so fast others have trouble following what the person is saying
• racing thoughts (muddled and disorganized)
• lack of focus
• restlessness and hyperactivity
• increased anxiety
• going for days with little or no sleep (without feeling tired)
• argumentative
• hypersexuality
• reckless or impulsive behavior

Some patients experience “mixed periods,” in which a combination of both manic and depressed symptoms occur within a very short time — one followed immediately by the other.

Researchers are not sure what causes or triggers symptoms of cyclothymia. The condition is, however, known to run in families.

A person does not have cyclothymia if they feel symptom-free for more than two months. To distinguish cyclothymia from regular moodiness, your doctor will compare your symptoms to the following clinical criteria:

• many periods of elevated mood (hypomania) and depression for at least two years (one year in children and teens) occurring at least half of the time
• periods of stable moods lasting less than two months
• symptoms that socially impact your daily life — at school, work, etc.
• symptoms that don’t meet the criteria for bipolar disorder, major depression or another mental disorder
• symptoms not caused by substance abuse or another medical condition

Your doctor will discuss your symptoms and medical history with you. He/she may also ask you questions about your use of drugs or alcohol.

Lab tests may also be performed to rule out other medical conditions that may be causing the symptoms.

Cyclothymia is a chronic condition that will require lifelong treatment. If you stop taking medications — even during periods of remission — your symptoms will return.

Because cyclothymia may develop into bipolar disorder, it is crucial that you receive appropriate treatments. Alcohol and drug use may increase your symptoms as well.

The main types of medications used to treat cyclothymia include:

• mood stabilizers such as lithium
• anti-seizure medications (also known as anticonvulsants) include divalproex sodium (Depakote), lamotrigine (Lamictal), and valproic acid (Depakene)
• atypical antipsychotic medications such as olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) may help patients who don’t respond to anti-seizure medications
• anti-anxiety medications such as benzodiazepine
• antidepressants should only be used in conjunction with a mood stabilizer as they may cause potentially harmful manic episodes when taken on their own

Psychotherapy is considered a vital part of the treatment of cyclothymia. The two primary types of psychotherapy used to treat cyclothymia are cognitive behavior therapy and well-being therapy.

Cognitive behavioral therapy focuses on identifying negative or unhealthy beliefs and behaviors and replacing them with positive or healthy ones. It may also help you manage stress and develop coping techniques.

Well-being therapy focuses on improving overall quality of life rather than fixing specific psychological symptoms. One recent clinical study found that a combination of cognitive behavioral therapy and well-being therapy bring significant improvements to the lives of patients with cyclothymia.

Other types of therapy that may benefit patients include talk, family, or group therapy.

There is no cure for cyclothymia, but there are treatments that will help you manage your symptoms. Your doctor will help you create a treatment plan that will most likely include a combination of medication and therapy.

It can be tempting to stop taking your medication or attending therapy sessions during episodes of hypomania. But it’s very important that you stick with your treatment plan.