Cyclothymia Treatment: Medication, Therapy, & Self-Help

What Is Cyclothymia?

Cyclothymic disorder (cyclothymia) is a mood-related condition that includes repeated periods of depressive and hypomanic symptoms. Individuals with cyclothymia report experiencing ‘highs and lows’ intermittently and unexpectedly. In cyclothymia, people have abrupt mood swings, poor emotional regulation, and often impulsive behaviors. The frequent patterns of emotional instability in cyclothymia can interfere with maintaining healthy relationships, careers, and life roles.^1,2,3
The symptoms of cyclothymic disorder are characteristic of bipolar disorder; however, in cyclothymia, they are less extreme and do not meet DSM-5 criteria for bipolar disorder types I and II. Additionally, the depressive features of cyclothymia are often milder and less long-lasting than major depressive disorders. Despite not being as severe as bipolar or major depressive disorders, cyclothymic disorder is still a serious and distressing mental health condition that requires psychological evaluation and treatment with qualified providers to support managing symptoms.^1,2

Other mental health conditions with overlapping symptoms include:²

• Major depressive disorder
• Bipolar II disorder
• Generalized anxiety disorder
• ADHD
• Borderline Personality Disorder
• Substance Abuse
• Psychotic disorders
• Traumatic Brain Injuries
• Bipolar disorders due to a medical condition (e.g., hyperthyroidism, auto-immune disorders)

How is Cyclothymia Disorder Diagnosed?

Although cyclothymia typically begins in childhood, it is rarely diagnosed due to individuals not seeking treatment or being misdiagnosed when they do.^3,4 If you believe you have symptoms of cyclothymia, it is essential to seek evaluation and treatment from a psychiatrist or other qualified mental health provider.

Mental health professionals will first rule out any medical or substance-related conditions that could be causing symptoms. They may refer you for testing, including bloodwork, urinalysis, brain imaging tests/scans, and substance use screens.¹ Once your provider rules out medical or substance causes, they will administer a biopsychosocial evaluation where they will ask about your symptoms, family history, and lifestyle or wellness factors. They may facilitate more specialized, objective assessments for further evaluation and to rule out similar mental health conditions, such as bipolar, depressive, and personality disorders.^1,3 Once your provider concludes that your symptoms are due to cyclothymic disorder, they will diagnose you and provide treatment recommendations.

Criteria to receive a cyclothymia disorder include:

• Symptoms have been present for at least 50% of the time for at least two years for adults and at least one year for children and adolescents
• You don’t experience more than two months without symptoms
• Your symptoms are not caused by substance use or a medical condition
• Symptoms must cause significant distress or impair daily functioning, but cannot be severe enough to meet the criteria for major depressive disorder or bipolar disorder

Reasons Some People With Cyclothymia Do Not Seek Treatment

Many people with cyclothymia do not seek help from professionals for their symptoms. It is common for people with cyclothymia to have a lack of awareness and insight about their disorder and its consequences when it is untreated. This is especially true when someone is in the hypomanic or ‘high’ symptom pattern of cyclothymia.⁴

Similarly, those around the person with cyclothymia may underestimate the severity of the disorder as the impact isn’t as extreme as the consequences seen with bipolar disorder, such as being psychiatrically hospitalized or having legal issues. Therefore, people in someone’s support system may not fully recognize the seriousness of the condition and recommend professional help.⁴

Additionally, some people feel shame about their impulsive behaviors, which causes them to avoid seeking help. Research supports that symptoms worsen for people who do not receive treatment.⁴ Therefore, it is essential that you follow up with a psychiatrist or other qualified healthcare provider if you believe you may have cyclothymia.

Self-Help Strategies to Manage Cyclothymia

Self-help strategies and lifestyle changes can help people manage symptoms and support their medical and therapeutic cyclothymia treatment. Self-help strategies may include learning more about cyclothymia through reading books or credible websites to increase understanding of coping skills they can use to manage behavioral and emotional patterns. Mood and behavior tracking can raise awareness about symptoms and help people further understand their cyclothymia. Individuals with cyclothymia should set exercise, diet, sleep, and overall self-care goals to promote wellness and support their treatment.

Lifestyle Modifications

To manage symptoms of cyclothymia, people should make healthy changes to their lifestyle. Your provider may recommend trying new activities or habits supporting your physical and mental health. If you currently engage in unhealthy behaviors, such as poor diet or substance abuse, your provider will likely encourage you to eliminate these or reduce them as much as possible.

Some lifestyle modifications to help manage cyclothymia symptoms include:

• Exercise: There are many exercise and mental health wellness benefits as it releases chemicals in our brain that can reduce negative stress. Specifically, exercise has been shown to reduce depressive symptoms, which occur in cyclothymia.⁵ Setting a daily goal to exercise, even in small ways, can help relieve cyclothymia symptoms.
• Diet: A healthy, balanced diet is critical for people with cyclothymia. Learning about the foods to eat and avoid for bipolar disorder can help with cyclothymia due to the similarities in conditions.
• Stress management techniques: Stress can worsen any mental health condition, including cyclothymia. Learning and implementing stress management techniques can help people with cyclothymia reduce their symptoms.
• Sleep: Consistent and quality sleep patterns are foundational for mental and physical health. Research has especially emphasized the importance of healthy sleep patterns for individuals with cyclothymia and bipolar disorder.^6,7
• Support system: Having a solid support system, which can include family, friends, or co-workers, can help promote symptom relief from cyclothymia. As it can be challenging for people to be fully aware of their symptoms, trusted support can help bring it to their awareness and encourage them to seek help.
• Avoiding substances (alcohol, drugs): It is common for people with bipolar or cyclothymia to abuse addictive substances, such as alcohol and drugs.⁸ However, substances such as these often worsen the severity of cyclothymic and bipolar disorders. Eliminating or significantly reducing use can help promote positive outcomes for treatment.
• Routine: While we may crave variety in our day-to-day, research supports that keeping a relatively consistent daily routine leads to symptom relief for individuals with cyclothymia .⁶ Implementing and sticking to a regular schedule can help manage cyclothymia symptoms.

Self Care & Relaxation Techniques

Self-care is finding ways to take yourself physically and mentally to promote wellness. Self-care helps reduce stress management, stay healthy, and reduce symptoms from mental health conditions. Regularly scheduled self-care activities and relaxation techniques can help relieve cyclothymia symptoms.

Some self-care and relaxation techniques to help manage symptoms include:

• Mindfulness Meditation: When people practice mindfulness, they engage in peaceful, present-moment awareness without judgment or criticism. Research supports that practicing mindfulness meditation reduces symptoms in people with mood and bipolar disorders, such as cyclothymia.^9,10
• Breathing: Breathing techniques, such as diaphragmatic breathing and deep breathing, help calm our nervous system, which can be activated for people with cyclothymia.¹¹ Practicing a few breathing techniques daily can help manage cyclothymia symptoms.
• Progressive muscle relaxation (PMR): PMR involves briefly constricting different muscle groups in your body, followed by slowly releasing the tension, which promotes relaxation. For example, someone may begin by contracting the muscles in their toes for several seconds, then releasing. They may move to their ankles and repeat this sequence as they gradually move to different muscles. PMR is effective in reducing stress and symptoms associated with mental health disorders, such as cyclothymia.¹¹
• Journaling: Journaling can help you process emotions that may feel overwhelming and confusing. Starting a journal and keeping up with it promotes healthy emotional expression. People with cyclothymia may benefit from a journal to track their mood, process frustrating emotions, or write positive communication statements to share with others.
• Guided imagery: Guided imagery involves imagining a calm and pleasing environment with prompted audio or on your own. For example, someone may close their eyes and imagine a setting, such as a beach, that feels peaceful. Research supports guided imagery as a stress reduction tool.¹³
• Hobbies: Having hobbies you are passionate about can help reduce stress and promote self-care. Hobbies include crafting, exercising, playing a game or sport, spending time in nature, creating art, and listening to music. Consider revisiting former hobbies or finding new activities to reduce stress, which will help with cyclothymia symptom management.
• Positivity and gratitude: A grateful and optimistic attitude can help instill hope for those with cyclothymia. Sharing or writing one thing you are thankful for or looking forward to can help promote positivity in your outlook.

Support Systems & Community Resources

Many people may feel alone in their cyclothymia. Opening up about what you are experiencing to trusted people in your support system, such as friends or family, can help you feel less isolated. Community resources like support groups, self-help groups, and online forums can help you connect with people with similar experiences. The Depression and Bipolar Support Alliance (DBSA) and BpHope offer supportive in-person and online groups as well as education for those with bipolar and cyclothymia.

Professional Treatment for Cyclothymia Disorder

Seeking professional help from qualified healthcare providers is essential to managing cyclothymia symptoms. Effective treatments for cyclothymia typically include therapy and medications. Your healthcare provider will help you understand more about cyclothymic disorder and ways to manage symptoms.

Cyclothymia Medication

While there are no psychiatric medications currently considered FDA-recommended for cyclothymia, medications used to treat other similar conditions can be effective.¹ Common medications used to treat cyclothymic disorder include mood stabilizers, anticonvulsants, antipsychotics, and antidepressants. However, recent research indicates that for some people, antidepressants and antipsychotics can worsen symptoms of cyclothymia; therefore, they should be considered with caution by providers.^1,3 Due to controversies regarding these medications, providers often start with low dosages and slowly increase them over time as medication effectiveness varies for everyone.³

Some common medications used to treat cyclothymia include:

• Mood stabilizers: Mood stabilizers are a type of medication used to treat common mood-related disorders such as bipolar disorders and schizoaffective disorder. Due to the similarities to bipolar disorder, mood stabilizers are also used to treat cyclothymia. The most commonly prescribed mood stabilizer is Lithium, which is considered a first-line pharmaceutical treatment for cyclothymia.³
• Anticonvulsants: Anticonvulsants, often categorized as mood stabilizers, are used to treat seizure disorders and mood-related disorders, such as bipolar and cyclothymia. Commonly prescribed anticonvulsants for mood stability in cyclothymia include Valproate and Lamotrigine.³
• Antidepressants: Antidepressants, medications for depression, may be used to treat cyclothymia, but their efficacy is often debated as some research suggests that antidepressants can worsen hypomanic symptoms, trigger mood swings, or wear off quickly.^3,13 Common antidepressants used for bipolar disorder and cyclothymia include Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants (TCAs), and Monoamine oxidase inhibitors (MAOIs).¹⁴
• Antipsychotics: Antipsychotics can be used alone or in combination with mood stabilizers to treat cyclothymia. However, their effectiveness is also controversial, as some people report increased hypomania while on antipsychotics. The most commonly prescribed antipsychotic for cyclothymia is Quetiapine.^3,13

Therapy

Research supports psychotherapy as an effective treatment for managing cyclothymia symptoms. While types of psychotherapy for cyclothymia may differ, the most common and evidenced-based approaches are cognitive behavioral therapy (CBT), family therapy, and psychoeducation. Many of the therapy options recommended for bipolar disorder treatments can be adjusted to treat cyclothymia due to the similarities in symptoms.^1,3

Common therapy options for cyclothymia treatment include:

• Cognitive behavioral therapy(CBT): CBT is considered the first-line psychotherapy approach for cyclothymic disorder.^1,15 Similar to CBT for bipolar disorder, your counselor will help you identify irrational, negative beliefs that contribute to cyclothymia and teach you how to think adaptively and positively to promote healthy behaviors.
• Family therapy: Family therapy is recommended for people with cyclothymia so that their loved ones can understand the disorder and support their symptom management.¹⁵ As cyclothymia often causes issues interpersonally, a therapist will also help you and your support system sustain healthy relationships.
• Psychoeducation: Often an essential part of all treatment options for cyclothymia, psychoeducation helps you learn more about your symptoms and their impact on your life, such as relationships, so that you understand and accept the challenges associated with the disorder.¹ When providing psychoeducation, the therapist will help you understand where cyclothymia is causing the most interference in your life so that you can develop positive coping skills to reduce the impact.³
• Interpersonal and Social Rhythm Therapy (IPSRT): IPSRT, a common mood disorder treatment, emphasizes sustaining healthy relationships and behaviors. In IPSRT, a therapist will help you learn interpersonal tools and establish regularity in your daily routines to maintain stability in life, which can often be challenging for those with cyclothymia.¹⁵
• Mindfulness-Based Cognitive Therapy (MBCT): MBCT is a behavioral therapy that encourages mindfulness and acceptance. Common exercises in MBCT include mindfulness practice, meditation, and yoga. It should be noted that more research is needed for MBCT with bipolar disorders and cyclothymia. However, studies so far are promising.^9,15
• Peer Support: In addition to treatment from a qualified mental health professional, peer support can offer additional relief in cyclothymia symptom management. Connecting with others who have similar experiences can help people learn more about their condition, identify valuable resources, and reduce the shame associated with cyclothymia.¹⁵ Peer support for cyclothymia is offered in person and virtually.
• Crisis, Inpatient, or Intensive Programs: In the event someone begins to develop thoughts to harm themselves or others due to cyclothymia symptoms, they should seek crisis services, such as crisis hotlines or local emergency departments. A crisis therapist in this setting will evaluate your symptoms and recommend appropriate treatment programs based on your mental health needs.

Where to Find Professional Help for Cyclothymia

If you believe you may have cyclothymia, getting a diagnosis and beginning treatment is crucial, as research suggests the condition worsens over time if it is untreated.^1,16 Finding a qualified mental health professional who can clarify your diagnosis is the first step.

You can find a therapist using this online therapist directory. While searching the online directory, you can specify preferences such as what insurance the provider accepts, therapist demographics, in-person or virtual appointments, and many more. Be sure to identify therapists who have experience and training in treating mood-related disorders, such as bipolar and cyclothymia. You can confirm this by using filtered options in your search or contacting the therapist directly to inquire about their specialties.