Cyclothymic Disorder

What Causes Cyclothymic Disorder?

Doctors and researchers have not determined precisely what causes cyclothymic disorder or bipolar disorder. Still, they have identified several risk factors that increase the likelihood of an individual developing the disorders.

• Genetic Predisposition. The general scientific understanding is that there isn’t a single gene that causes bipolar disorder. However, there is a strong connection between family history of the disorder and new diagnoses of the illness; those with a close relative with bipolar disorder are significantly more likely to develop the disorder themselves. The current consensus is that multiple genes contribute to an increased risk for developing the disorder. External environmental factors may trigger these genes to cause the onset of the illness.
• Stress, Anxiety, or Trauma. Some research has suggested that the brains of people with bipolar disorder cannot effectively cope with stress. Chronic stress or anxiety, or a significant source of sudden trauma, often coincides with the disorder’s onset, and these factors may also trigger subsequent episodes after the disorder first occurs.
• Lack of Sleep. Many sufferers of bipolar disorder experience unhealthy sleep patterns, and lack of sleep is a cause of physical stress that may contribute to the brain chemistry that causes the illness. Like other forms of stress, lack of sleep may also contribute to manic or depressive episodes after the initial onset of the disorder.
• Drugs and Alcohol. Nearly half of all people with bipolar disorder also struggle with drug or alcohol abuse. Sufferers often resort to substance abuse to cope with the effects of manic and depressive episodes, and the stress caused by the substance abuse may be a factor in triggering subsequent episodes. In some cases, antidepressants may also trigger episodes.

Is Cyclothymic Disorder Hereditary?

There appears to be some genetic component of risk for developing cyclothymic disorder, but the medical community has not pinpointed the specific genes that increase risk. However, there is a significant link between family history of CD or BD (as well as major depression) and the disorder’s diagnosis in new patients.

• Individuals with one biological parent who has been diagnosed with the disorder have a 10-25% chance of developing the disorder themselves. When both parents have been diagnosed with the condition, the risk increases to 10-50%.
• Individuals with a sibling or non-identical twin who has been diagnosed as bipolar have a 10-25% chance of developing the disorder. If an identical twin has the disorder, the possibility of the other twin developing the condition rises to 40-70%.
• The current consensus among researchers is that bipolar disorder is not caused by a single gene but by a coincidence of several genes that each increase the risk of developing the disorder. In addition, environmental factors likely trigger the development of the condition even in individuals with genetic risk factors.

How Is Cyclothymic Disorder Detected?

Early detection of cyclothymic disorder is challenging, and the disorder may sometimes be mistaken for other mental and physical disorders with similar symptoms. Therefore, loved ones and healthcare providers are encouraged to watch for symptoms such as mood swings, mania, depression, or episodes that coincide with other risk factors such as stress, anxiety, sleep problems, trauma, family history of the disorder, or drug and alcohol abuse.

How Is Cyclothymic Disorder Diagnosed?

Diagnosis of cyclothymic disorder begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that CD or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

• A physical exam. This exam aims at ruling out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for CD. These criteria include:

• The person has experienced hypomanic and depressive episodes for at least two years. These episodes don’t meet the diagnostic criteria for hypomania or major depressive disorder.
• The episodes have been present at least half the time, with no period of remission longer than two months.
• The symptoms don’t meet the diagnostic criteria for bipolar disorder, major depressive disorder, or another mental disorder.
• The symptoms cause significant distress or impairment of daily functioning.
• The symptoms aren’t caused by substance use or a medical condition.

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How Is Cyclothymic Disorder Treated?

There is no known cure for cyclothymic disorder, and treatment plans are intended to manage symptoms and lessen the severity of episodes when they occur. Treatment for cyclothymic disorder is life-long, and patients need to continue treatment without interruption as directed by their healthcare providers.

Medication

The Food and Drug Administration has not approved any medications specifically for treating cyclothymic disorder. However, doctors may sometimes prescribe drugs used to treat bipolar disorder. These drugs may include:

• Mood Stabilizers. These drugs are usually used to manage manic episodes. Mood-stabilizing drugs commonly prescribed for bipolar disorder include lithium, valproic acid, divalproex sodium, carbamazepine, and lamotrigine.
• Antidepressants. These drugs are typically used to manage depressive episodes in people living with bipolar disorder. However, antidepressants used alone are known in some cases to trigger manic episodes or rapid cycling, so they are usually used in combination with mood-stabilizing or antipsychotic drugs.
• Antipsychotics. These drugs are generally prescribed when the symptoms of manic or depressive episodes don’t respond adequately to other medications alone. Commonly prescribed antipsychotics include olanzapine, risperidone, and quetiapine.
• Anti-Anxiety Medications. Anti-anxiety drugs such as benzodiazepines are sometimes used to treat anxiety or sleep problems in bipolar sufferers, typically on a short-term basis.

Psychotherapy

Psychotherapy and counseling may help the patient decrease stress and establish behaviors that help lessen the impact of symptoms.

How Does Cyclothymic Disorder Progress?

While the symptoms of cyclothymic disorder are relatively mild compared to more severe conditions, CD can lead to serious complications if left untreated. Potential long-term consequences of untreated cyclothymia include:

• Relationship problems
• Risk of developing bipolar disorder
• Risk of developing other mental health-related issues such as anxiety disorders
• Substance abuse
• Suicidal thoughts, suicide attempts, or suicide

How Is Cyclothymic Disorder Prevented?

The onset of cyclothymic disorder cannot be prevented, but early recognition of an episode’s signs can help the person manage the oncoming episode. Therefore, it is vital for those diagnosed with CD to seek regular evaluation from their mental health providers and adhere faithfully to any prescribed medication plan.

Cyclothymic Disorder Caregiver Tips

In addition to seeking support from therapy or a support group, caregivers for someone with cyclothymic disorder should consider some of the following self-care tips:

• Learn as much as possible about the condition.
• Make time for yourself away from the disorder.
• Take care of your own physical and mental health. Unfortunately, it is not uncommon for caregivers to experience depression or let their own healthy lifestyle suffer because of stress.

Many people with cyclothymic disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the conditions commonly associated with CD:

• CD is considered to be a mild form of bipolar disorder (BD)
• Some people with CD also have ADHD.
• Many people with CD also have an anxiety disorder at some point in their lives.
• Alcoholism and substance use disorder are commonly comorbid with CD.

Cyclothymic Disorder Brain Science

The causes of cyclothymic disorder and bipolar disorder have remained elusive for researchers. Still, recent studies have begun to shed new light on brain function and chemistry that could soon revolutionize the diagnosis and treatment of the disorder.

• Researchers have identified a difference in brain activity between people with bipolar disorder and those suffering from major depression. The study used MRI scans to look at the function of the amygdala, a part of the brain that is instrumental in the processing of emotion, and found that the left side of the amygdala is less active in people with bipolar disorder than in people with depression. This finding could help lessen the misdiagnosis of depression in people who are actually suffering from bipolar disorder.
• Researchers have found that people with bipolar disorder have generally poorer cognitive abilities such as memory, processing speed, and executive functioning than those without bipolar disorder.
• A recent study found that people with bipolar disorder who participated in brain-training exercises designed to boost cognitive abilities saw a significant and sustained improvement in their cognitive skills. The hope is that this kind of brain training can help bipolar sufferers improve their quality of life.
• An international research team has suggested a connection between a gene called EGR3 and a protein called brain-derived neurotrophic factor (BDNF), which, in normal conditions, helps the brain react effectively to stress. Previous studies have shown that people with bipolar disorder have lower levels of BDNF during manic or depressive episodes, and this new research suggests that it may be possible to develop drugs that will improve the function of EGR3 and BDNF in bipolar sufferers.

Cyclothymic Disorder Research

Title: Unobtrusive Monitoring of Affective Symptoms and Cognition Using Keyboard Dynamics (UnMASCK) (UnMASCK)

Stage: Recruiting

Principal investigator: Olusola Ajilore, MD, PhD

University of Illinois at Chicago

Chicago, IL

Mood disorders are associated with significant financial and health costs for the United States, partially due to cognitive problems in these patients that can worsen disease course and impair treatment response. This study proposes using smartphone-based technology to monitor cognitive problems in patients with mood disorders by linking brain network changes with predicted worsening mood symptoms. The proposed study will provide evidence for using smartphone-based passive sensing as a cost-effective way to predict illness course and treatment response.

Title: The Influence of the Menstrual Cycle on Lithium and Sertraline Blood Levels

Stage: Completed

Principal investigator: Mallay B. Occhiogrosso, MD

Weill Cornell Medical College

New York, NY

This study aims to determine whether blood levels of lithium or sertraline are affected by different phases of the menstrual cycle and whether there is an effect on psychiatric symptoms. Subjects are seen for two visits: one visit during the luteal phase and one visit during the follicular phase of the menstrual cycle. They will fill out a depression, anxiety, and mania rating scale on each visit. Also, a 20mL blood sample will be drawn at each visit to measure progesterone level and either a lithium or sertraline level, depending on which medication the patient takes. The primary hypothesis in this study is that blood levels of lithium and sertraline will be significantly lower in women during the luteal phase of the menstrual cycle than during the follicular phase. Examination will also be made of whether symptoms will increase in severity during the luteal phase compared to the follicular phase. The investigators expect a negative linear association between symptom severity and blood level, i.e., expect symptom severity to worsen as blood levels of lithium or sertraline decrease.

Title: Early Intervention for Youth at Risk for Bipolar Disorder

Stage: Completed

Principal investigator: David J Miklowitz, PhD

University of California, Los Angeles

Los Angeles, CA

Children or teens with mood swings or depression who have a parent with bipolar disorder are at high risk for developing bipolar disorder themselves. This study will test a family-based therapy aimed at preventing or reducing the early symptoms of bipolar disorder in high-risk children (ages 9-17). In a randomized trial, the investigators will compare two kinds of family-based treatment (one more and one less intensive) on the course of early mood symptoms and social functioning among high-risk children followed for up to 4 years. The investigators will examine the effects of family treatment on measures of neural activation using functional magnetic resonance imaging.