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Cyclothymic disorder: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Cyclothymic disorder is characterized by hypomanic and mild depressive periods that last a few days, are irregular, and are less severe than those in bipolar disorder. Diagnosis is clinical and based on history. Treatment is primarily educational, although some patients with impaired functioning require medication.
Cyclothymic disorder is often a precursor to bipolar II disorder. However, it can also present with marked mood changes that do not reach the level of major depressive disorder. In chronic hypomania, a form rarely observed clinically, periods of elevated mood predominate, with sleep duration typically decreasing to less than 6 hours. Such patients are constantly cheerful, self-confident, overly energetic, full of plans, wasteful, and intrusive; they pursue their restless urges and are a nuisance to others.
For some people, the cyclothymic and chronic hypomanic states contribute to success in business, leadership, achievement, and artistic creativity; however, such people are more likely to have problems in interpersonal relationships and social connections and social consequences. Consequences typically include instability and irregularity in work, education, impulsivity and frequent changes of residence, repeated breakdowns in love and marital relationships, and episodic abuse of alcohol and drugs.
[ How is cyclothymic disorder treated?
Patients should be taught how to live with such extremes of character. However, living with cyclothymic disorder is not easy, because interpersonal relationships in such patients are often very stormy. Flexible work schedules are recommended. Patients with artistic inclinations should be encouraged to pursue a career in the arts, because the extremes and instability of cyclothymia may be easier to bear.
The decision to use mood stabilizers depends on the balance between functional impairment and any social success or creative drive the patient may have. Divalproex 500-1000 mg/day may be better tolerated than an equivalent dose of lithium. If depressive symptoms are mild and short-lived, antidepressants should be avoided because of the risk of polarity shift and rapid cycling.