Generality
Cyclothymia, or cyclothymic disorder, is a mood disorder, whereby those affected alternate moments of moderate depression (depressive episodes) with moments of euphoria and excitement (hypomanic episodes). "last, it is less serious.
For a precise diagnosis of cyclothymia, physical examination, some laboratory tests and evaluation of the psychological profile are essential.
The therapy, consisting of psychotherapy, mood stabilizing drugs and antidepressant drugs, aims to limit symptoms and possible complications.
What is cyclothymia?
Cyclothymia, or cyclothymic disorder, is a mood disorder characterized by emotional swings, ranging from moderate depression to a state of euphoria and excitement.
For the effects it induces, cyclothymia closely resembles bipolar disorder; compared to the latter, however, it is responsible for less intense symptoms. In fact, the associated depressive state is less severe (NB: in the case of bipolar disorder we speak of major depression), as well as less severe is the feeling of euphoria and excitement .
EPIDEMIOLOGY
Cyclothymia is a rather rare mood disorder. However, it should be pointed out that the data relating to its diffusion are scarce and unreliable, as it is a problem that often goes unnoticed or that in any case is not accurately diagnosed.
The reasons for this lack of response are most likely linked to the fact that many cyclothymic patients manage to lead a normal life, without particular difficulties.
The incidence of cyclothymia in both sexes is almost the same.
For reasons still unclear, cyclothymic disorder primarily affects young people and young adults.
ORIGIN OF THE NAME CYCLOTHYMY
The word "cyclothymia" comes from the Greek word "kyklotimia' (κυκλοθυμία), fruit of the union between:
- Kyklos (κῦκλος), which means "circle" or "circle", e
- Thymos (θυμός), which means "mood".
The use of the word cyclothymia derives from the emotional swings that characterize the mood disorder in question.
Causes
At the present time, the precise causes of cyclothymia are a mystery.
According to the most reliable hypotheses, a combination of hereditary, biochemical and environmental factors would play a decisive role in the onset of cyclothymic disorder.
HERITAGE FACTORS
By studying a large number of clinical cases, the researchers noted that cyclothymia tends to recur within the same family: several patients, among those considered, had more or less distant relatives affected by the same mood disorder or bipolar disorder.
All this has led scholars to hypothesize that cyclothymic disorder may have, at least in some circumstances, a genetic-hereditary basis.
The idea that hereditary factors can influence the onset of cyclothymia is particularly interesting, but it requires further study before it can be considered fully reliable.
BIOCHEMICAL FACTORS
According to some experiments, some alterations of the biochemical processes that take place in the brain are also decisive in the appearance of cyclothymia.
The theories in this regard are still full of question marks, which only future research will be able to definitively clarify.
ENVIRONMENTAL FACTORS
Premise: an environmental factor is any circumstance, event or habit that can affect the life of an individual, to a certain extent.
Doctors and experts in the field of mood disorders have observed that the past of cyclothymic patients often presents traumatic experiences (both emotionally and physically) or long periods of stress.
From this, they hypothesized that cyclothymia may be dependent on events from the past, experienced in a particularly intense and upsetting way.
Symptoms and Complications
For further information: Symptoms Cyclothymic disorder
Those suffering from cyclothymia alternate hypomanic episodes, marked by euphoria and excitement, with depressive episodes, characterized by mild to moderate depression.
Therefore, the symptoms and signs of cyclothymia are extremely variable.
HYPOMANIACAL EPISODES: TYPICAL SYMPTOMS
During hypomanic episodes, the subject with cyclothymia typically exhibits:
- An exaggerated feeling of happiness and well-being (euphoria)
- Extreme optimism
- Extreme self-esteem
- Extreme talkativeness (talk more than normal)
- Poor judgment skills, which can even lead him to make dangerous gestures or risky choices for his own safety
- Quick thinking
- Agitated or irritable behaviors
- A particular tendency to excessive physical activity
- A particular willingness to want to achieve certain results
- Poor need for sleep
- A particular tendency to distraction
- A particular inability to concentrate properly
DEPRESSIVE EPISODES: TYPICAL SYMPTOMS
Typically, the depressive episodes of cyclotomy characterize:
- Sadness, hopelessness and a sense of emptiness
- Cry
- Irritability (especially in younger people)
- Loss of interest in all those activities, which usually represent an enjoyment or an appreciated pastime
- Weight changes
- Trouble sleeping at night
- Sense of worthlessness or guilt
- Restlessness
- Sense of fatigue and slowness in doing things
- Problems with concentration
- Suicidal thoughts
PERIODS OF STABILITY: DO THEY EXIST?
It is wrong to think of cyclothymia as a continuous alternation of mood swings.
There are, in fact, periods of humoral stability, in which the cyclothymic patient seems normal.
These periods of stability generally last less than two months.
WHEN TO SEE THE DOCTOR?
Anyone suffering from cyclothymia (or suspected of being affected) should immediately contact a specialized doctor or an expert in mental and mood disorders, to analyze the situation in detail and undergo appropriate treatment.
If you are a relative of an individual who is probably cyclothymic, who does not realize that he has problems, it is necessary to try to refer him to an expert or a specialized doctor.
COMPLICATIONS
If not treated, cyclothymia can have various complications.
The most important complications of cyclothymia include:
- The onset of emotional problems that can affect the quality of life.
- A particular tendency to develop so-called bipolar disorder.
- The abuse of drugs or alcohol.
- A particular tendency to develop anxiety disorders.
Diagnosis
For the purposes of a correct diagnosis of cyclothymia, the following are essential: an accurate physical examination, some laboratory tests, a "careful evaluation of the psychological profile and, finally, the consultation of the so-called Diagnostic and Statistical Manual of Mental Disorders (DSM).
The DSM is a collection of all the peculiar characteristics of known psychic and mental illnesses (including mood disorders), including the respective criteria required for diagnosis.
WHO IS THE DIAGNOSIS FOR?
Usually, the diagnosis of cyclothymia requires the involvement of a team of professionals, including general practitioners, psychiatrists and psychologists.
OBJECTIVE EXAMINATION AND LABORATORY TEST
Physical examination and laboratory tests clarify whether the symptoms and signs present are related to some physical problem, rather than to cyclothymia.
In addition, they are excellent indicators of the patient's general health condition.
EVALUATION OF THE PSYCHOLOGICAL PROFILE
The assessment of the psychological profile is the responsibility of a psychiatrist or a psychologist and consists of a discussion between one of these two professional figures and the patient.
The topic of the discussion is everything related to the patient's emotional and behavioral sphere, his thoughts and feelings.
Furthermore, at the end of the discussion, there is a questionnaire whose purpose is to investigate, once again, the emotionality, the behavior, the thoughts and the sensations.
DIAGNOSIS ON THE BASIS OF DSM
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, an individual suffers from cyclothymia if:
- You have been experiencing hypomanic episodes, alternating with depressive episodes, for at least two years, in the case of adults, or for at least a year, in the case of children or adolescents.
- The periods when the mood is stable last less than two months.
- Emotional fluctuations severely affect the social sphere (therefore interpersonal relationships), the "workplace," school environment, etc.
- The symptoms and signs found during the psychological evaluation do not coincide with those of bipolar disorder, major depression or another mood disorder (eg dysthymia).
- The emotional swings are not due to substance abuse or physical problems.
Treatment
Cyclothymia is a mood disorder that accompanies those affected throughout their lives.
However, with proper treatment, it is possible to tangibly limit the symptoms and possible complications.
Cyclothymia therapy is based on the use of psychotherapy techniques, sometimes associated with the administration of specific drugs against mood disorders and depression.
THERAPEUTIC OBJECTIVES
Briefly, the objectives of the planned therapy in case of cyclothymia are:
- Reduce the patient's risk of developing so-called bipolar disorder. Remember that cyclothymia is comparable to a less intense form of bipolar disorder, which can be a prelude to the latter.
- Reduce the frequency and severity of symptoms and signs, which characterize hypomanic and depressive episodes.
This allows the patient to enjoy their life better. - Prevent possible relapses.
- Treat any drug or alcohol addictions.
PSYCHOTHERAPY
The basic psychotherapy techniques for the treatment of cyclothymia include:
- Cognitive-behavioral therapy. This form of psychotherapy aims to teach the cyclothymic patient how to identify and master problematic behaviors (in specialist jargon, "inactive" or "distorted thinking" behaviors), which characterize hypomanic and depressive episodes.
Furthermore, it is of enormous help in the "identification of the so-called" triggers ", ie the factors that trigger the symptoms.
Cognitive-behavioral therapy includes a part "in the studio", with the psychotherapist, and a part "at home", reserved for the exercise and improvement of mastery techniques. - Interpersonal therapy. This psychotherapy technique is based on the "idea that interpersonal relationships and with the outside world in general have a" decisive influence on a person's mental health.
According to those who practice interpersonal therapy, cyclothymia originates from situations of emotional or physical stress, following a problematic relationship with other people, with work, with school, etc.
The therapeutic goal is to find out which interpersonal relationships triggered the development of the mood disorder in question and, once this is clarified, to find a possible remedy. - Interpersonal and social rhythm therapy. This form of psychotherapy is a variant of the previous interpersonal therapy.
In addition to the aims of interpersonal therapy, it has the particular objective of stabilizing and adjusting - based on the mood disturbance in progress - the patient's biological rhythms and sleep-wake rhythms.
The basic idea is that a regular daily routine is of great benefit to the mental health of the cyclothymic subject.
Other psychotherapy techniques adopted in case of cyclothymia:
- Psychodynamic therapy
- Group therapy
- Dialectical Behavioral Therapy
PHARMACOLOGICAL THERAPY FOR CYCLOTHYMY
The FDA, the US government body for the regulation of food and pharmaceuticals, believes that there are no specific drugs for the treatment of cyclothymia, so it has never approved their use.
However, according to what emerges from some clinical studies, cyclothymic patients would benefit from "taking the same antidepressant and mood stabilizing drugs, used for the treatment of bipolar disorder (NB: this is a" further confirmation of the existing link between the two psychic conditions).
The effect of the aforementioned drugs would help to better control the symptoms of cyclothymia and prevent hypomanic and depressive episodes.
- Lithium carbonate
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Antiepileptics (lamotrigine, valproate or carbamazepine)
- Tricyclic antidepressants
- Monoamine oxidase type A inhibitors (MAOIs)
- Atypical antidepressants (ex: bupropion)
SOME MEDICAL ADVICE
For cyclothymia treatments to have better effects, doctors strongly recommend:
- Undergo the treatment provided, without skipping any psychotherapy session or drug administration. Scrupulously following the therapeutic procedure is essential to avoid relapses; moreover, it indicates that the patient is aware of his condition and the need to be treated.
- Avoid drinking alcohol and using drugs. Alcohol and drugs induce mood swings and this can worsen the emotional swings of the cyclothymic.
- Consult your doctor before taking any medicine. Some medications may interfere with medications taken to control cyclothymia.
- Keep a journal in which to record your daily mood, events that induced an emotional swing, etc.
All this is of considerable help especially for the psychotherapist, when he is preparing to set up future psychotherapeutic sessions. - Exercise regularly. Exercise has beneficial effects on mood, as it induces the release of endorphins, ie chemicals linked to a particular sense of well-being and fulfillment.
- Sleep the right number of hours and avoid "being late" in the evening. Regular night sleep plays a vital role in stabilizing mood.
Prognosis
If the treatments are adequate and the patient is scrupulous in following them, cyclothymia is a manageable mood disorder with a positive or, at least, not negative prognosis.
Prevention
Mood disorder experts agree that there is currently no surefire way to prevent cyclothymic disorder.
However, they are convinced that the timely initiation of treatments avoids a worsening of the emotional fluctuations, typical of cyclothymia.
