cyclothymia: a seldom explored explanation for treatment-resistant ups & downs
In today’s climate, the average person experiences an array of emotions throughout the day that might contradict each other. Jobs are demanding, parenthood is exhausting, connecting with others is harder than ever, and with the influx of subliminal messaging from social media about what your life should look like, our minds are overloaded with way more information than a healthy brain is likely intended to consume. This, unsurprisingly, all creates a perfect breeding ground for all sorts of mental health issues to arise. In fact, according to The National Alliance on Mental Illness, 20% of American adults (50+ million people) experience some type of mental illness annually, and that’s just what’s been reported — we all have family members who refuse to see mental health practitioners that undoubtedly suffer from some sort of mood or personality disorder. I’d say it’s more like 50%, based on the sample size I see in everyday life. With that being said, some mental illnesses remain more stigmatized than others. Bipolar disorder is one of them. It is a commonly misunderstood condition, with people casually weaponizing it in everyday life to label someone’s change in mood or feelings.
There are four types, and the third is the star of today’s post. Bipolar I is the most acute type, which features mania (lasting a week, at least) and commonly depressive episodes, but not always. About 50% to 95% of people suffering from this disorder experience psychosis, according to The Centre for Addiction and Mental Health, which can range from hallucinations to simply having incredibly disorganized thoughts & unregulated, intense aggravation. Oftentimes, hospitalization is a common theme in the lives of those suffering. Bipolar II is characterized by depressive episodes, featuring fatigue, loss of enjoyment in life, feelings of worthlessness, and even suicidal thoughts/tendencies. These depressive symptoms can last for weeks, months or in rare cases, years. It’s more similar to clinical depression, but different in the fact that it includes hypomanic episodes in contrast to these periods of depression. While major depressive disorder is more chronic and consistent, Bipolar II features more ups & downs. However, it is worth noting that hypomania is different than mania. It is a less intense form with milder behavior for a much shorter time frame. In most cases, it is not severe enough to cause a detrimental impact on the lives of those living with it. It more-so includes feelings of euphoria, high energy, restlessness, an influx of ideas, excitement, and more.
80% to 90% of those suffering from bipolar disorder have a relative who suffered from it as well, according to The American Psychiatric Association, lending to the theory that it is typically genetic and passed down through generations. The Association also writes that it is typically also co-morbid with ADD/ADHD, anxiety and/or substance abuse. If medicated for these conditions, it usually means that you’ll be polypharmaceutical, but not always. The fourth type of bipolar (Unspecified Bipolar) is a little more ambiguous — it doesn’t meet the criteria for the other types, but still shows elevated moods followed by low moods.
Onto the heart of this article: cyclothymia. Different from the weeks or days of hypomania or depressive episodes, cyclothymia is characterized by rapid mood cycling throughout the day. The mood swings are mild, but still present and noticeable. While it is claimed to be the rarest form of bipolar, it may just be that the mood swings are mild enough that those with it are still able to go on with their lives without feeling the need to treat it. With the absence of psychosis and impulsivity, it is seldom addressed, yet many people, likely more than the reported percentage, suffer from it. In fact, in talking to others, most people had at least one person in their family who they suspected suffered from it. It is commonly triggered by a significant life trauma, along with being genetic, but the two likely intersect because those who experience trauma, especially in older generations, can sometimes project it onto their children if they aren’t self-aware enough to take the proper steps to heal and grow.
Notably, SSRIs & SNRIs commonly prescribed to treat chronic depression are actually not recommended for cyclothymia (or bipolar in general) because they can worsen symptoms of hypomania/mania and are not known to improve the hallmark ups & downs of bipolar (Cleveland Clinic). Instead, mood stabilizers, such as Lithium or Lamotrigine, are commonly prescribed to stabilize the ups & downs and can sometimes alleviate depression & anxiety as well (off-label, though).
Do you feel like perhaps your ADHD or depression could be misdiagnosed cyclothymia based on the description of the symptoms? Hopefully this article helps — whether it just added to your mental health knowledge or sparked an idea that could help help alleviate any mental health struggles you’re going through. Sending love to everyone suffering or who has a loved one struggling. <3
Helpful Resources
https://www.webmd.com/bipolar-disorder/cyclothymia-cyclothymic-disorder
https://my.clevelandclinic.org/health/diseases/17788-cyclothymia
https://www.healthline.com/health/depression/cyclothymia#treatments
https://www.mayoclinic.org/diseases-conditions/cyclothymia/diagnosis-treatment/drc-20371281 — points out that “treatment decrease[s] your risk of bipolar I or II disorder, because cyclothymia carries a high risk of developing into bipolar disorder.”
