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Ask the Mental Health Expert Archives 2001-2004

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Cyclothymic Disorder

Q. I have been diagnosed with Cyclothymic Disorder. The information from the Internet makes no sense to me because it was compared to other disorders. Can you give me information on the symptoms and disability? Is it hereditary?

A. Cyclothymic Disorder (Cyclothymia) is a condition in which the individual experiences frequent mood swings that adversely affect his or her social or vocational function. Cyclothymic Disorder (CD) is more than having a bad hair day now and then. It is considered to be part of the so-called bipolar disorder spectrum, which includes classical (type 1) manic-depressive disorder; type 2 bipolar disorder; and cyclothymia.

In type 1 bipolar disorder, the individual has severe mood swings that include mania and major depression. A manic bout is a severe upward swing in mood and energy that almost always requires hospitalization. The person may become psychotic, or so irritable that he or she becomes physically aggressive. This is not the case with either type 2 bipolar disorder or cyclothymia. In these conditions, the upswings are not as high or as debilitating--people develop what are termed hypomanic episodes. In these upward mood shifts, the person often feels highly energized, needs less sleep than usual, becomes more active socially or sexually, and often gets a good deal of work done. (Some, however, can feel wired or irritable). That's the up side of type 2 bipolar disorder and cyclothymia.

The down side is that inevitably, the person's mood takes a dramatic downturn. In type 2 bipolar disorder, this reaches the depth of a major depressive episode. The person may become severely withdrawn; lose interest in nearly all activities; experience severe insomnia and loss of appetite; feel extremely guilty or self-hating; and experience suicidal impulses. In cyclothymia, the person's depressive bouts do not reach this level of severity or intensity, but may still be quite distressing and incapacitating. People with frequent cyclothmic mood swings may find it hard to hold down a steady job, or to form stable relationships. Some may turn to alcohol or substance abuse in order to self-medicate their mood swings. But there are probably different subtypes of cyclothymic disorder, some of which are more debilitating than others, and some, more closely related to classic (bipolar 1) manic-depressive disorder.

Cyclothymia and bipolar disorder in general are almost certainly not hereditary in the way that blond hair or blue eyes are inherited. However, there is evidence pointing toward a tendency to inherit bipolar disorder. For example, there is a high probability that if one identical twin has bipolar disorder, the other will, too, even if raised in a different household--but the odds are not 100%, as would be the case with eye or hair color.

Though there is a strong biological/genetic component to bipolar disorder, psychological and social factors also influence the frequency and severity of the mood swings. Individuals with type 1 bipolar disorder virtually always require mood-stabilizing medication. This is usually true for those with bipolar 2 disorder as well. It's not so clear with cyclothymic individuals--some may require mood-stabilizing medication (such as lithium or lamotrigine), others may not.

This is an important issue to discuss with your doctor. Supportive/educational counseling or psychotherapy aimed at helping you manage this condition is probably a wise idea. It's also important to make sure there are no medical factors underlying your mood swings; for example, abnormal thyroid function, vitamin deficiency, etc.

For more information on bipolar spectrum disorders, I would suggest getting in touch with the National Manic and Manic-Depressive Association [NDMDA] chapter in your area; their national number is 800-826-3632. There's every reason to be optimistic about dealing with this condition, if you get the right kind of help!

August 2002

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