Cyclothymia: symptoms, treatment and how it differs from bipolar disorder

The NHS says that if you have cyclothymia you will have periods of feeling low followed by periods of feeling very happy and excited, called hypomania. During the highs you do not need much sleep, are more sociable and impulsive and feel that you have a lot of energy.

The periods of low mood do not last long enough and are not severe enough to be diagnosed as depression. The NHS says you might feel sluggish and lose interest in things during these periods, but this should not stop you going about your day-to-day life. Symptoms are not severe enough for a diagnosis of full bipolar disorder, and mood swings are broken up by periods of normal mood.

Mood swings are fairly frequent. The NHS says you will not go for longer than 2 months without experiencing low mood or an emotional high. It adds that the mood swings can affect daily life and cause problems with personal and work relationships.

• Periods of low mood that are milder than depression, with feeling sluggish and losing interest in things.

• Periods of hypomania: feeling very happy and excited, needing less sleep, being more sociable and impulsive and having a lot of energy.

• Normal mood in between, with changes recurring fairly often.

The NHS describes cyclothymia as a mild form of bipolar disorder that causes mood changes from feeling low to emotional highs. People can get cyclothymia at any age. Because the symptoms are mild, or because the highs feel pleasant, many people do not realise there is anything wrong and do not seek help. This is why the NHS says it often goes undiagnosed and untreated.

Bipolar UK explains that a diagnosis of cyclothymia means someone has experienced regular episodes of hypomania and depression for at least two years, but these are not severe enough to meet the full criteria for a mood episode. It says people with cyclothymia are on the bipolar spectrum but do not have a diagnosis of bipolar disorder, although cyclothymia can develop into bipolar disorder.

The NHS says treatment usually involves some kind of talking therapy (psychotherapy), and you may also need medicines. The aims are to stop cyclothymia developing into full bipolar disorder, reduce your symptoms and stop them coming back.

Psychotherapy, such as cognitive behavioural therapy (CBT), involves talking to a trained therapist to find ways to manage symptoms by changing the way you think and behave. You are given practical ways to improve your state of mind each day.

You may be prescribed medicines to level out your mood (mood stabilisers). The NHS lists lithium, commonly used to treat bipolar disorder, and epilepsy medicines such as carbamazepine, oxcarbazepine or sodium valproate. Some antipsychotics such as quetiapine are also sometimes used as mood stabilisers. The NHS notes that not all people with cyclothymia need or respond to medicine.

The NHS also suggests that you may find it helpful to join a support group to talk to others who share your experiences, and says you can ask your mental health service or GP about local groups. Bipolar UK, Mind and Rethink Mental Illness are listed as organisations that can help.

The NHS and Bipolar UK both place cyclothymia on the bipolar spectrum but describe it as milder than full bipolar disorder. The table below sets out how they are described.

The NHS says the causes of cyclothymia are not known, but there is probably a genetic link because cyclothymia, depression and bipolar disorder all tend to run in families. In some people traumatic events or experiences, such as severe illness or long periods of stress, may act as a trigger.

The NHS says doctors may diagnose cyclothymia if you have had symptoms for at least 2 years, or 1 year for children and teenagers. In its bipolar disorder guidance, the NHS says that a GP who thinks you may have bipolar disorder or another mental health condition will refer you to a mental health specialist (psychiatrist), who will ask about your moods, behaviour, health and family history.

The NHS notes that bipolar disorder can take time to diagnose because it affects everyone differently and the symptoms are similar to other mental health conditions. The same difficulty applies to cyclothymia, which is often not diagnosed at all.

The NHS says it is not known how many people with cyclothymia will go on to develop full bipolar disorder. Some see their elevated or depressed moods become more severe, while others find that cyclothymia continues and need to manage it as a lifelong condition.

For bipolar disorder, the NHS says it is important to know what can trigger your high and low moods, such as stress, not getting enough sleep or being too busy. It suggests having a regular routine, getting plenty of sleep, eating a healthy diet, exercising regularly and managing stress, and avoiding recreational drugs, smoking and drinking too much alcohol. These are described for bipolar disorder rather than cyclothymia, but they are the same kind of self-management that many people with mood conditions use.

The NHS says that if you think you have cyclothymia, it is important to seek help from a GP, partly because people with cyclothymia are at risk of developing full bipolar disorder. In its bipolar guidance, the NHS says to see a GP if you have extreme changes in your moods that last a long time or affect your everyday life, or if you have been diagnosed and treatments are not helping.

Low mood can include thoughts of suicide or of harming yourself. The NHS says support is available if you or someone you know is having a mental health crisis or emergency, no matter what you are going through, and points to its page on where to get urgent help for mental health. If someone is in immediate danger, call 999.

On the NHS, the usual first step is a GP appointment. The GP can discuss your symptoms and, where appropriate, refer you to talking therapy or to a mental health specialist. Treatment may include talking therapy such as CBT and medicines prescribed by a doctor.

Some people choose private psychiatry or private therapy, often for faster access. The assessment and treatment options described by the NHS are broadly the same, and you should tell your GP if you start private treatment so that your care stays joined up.