Cyclothymia: Chronic Mood Cycling Between Hypomania and Depression

Diagnostic Criteria (DSM-5)

• ≥2 years (≥1 year in adolescents) of numerous hypomanic and depressive periods not meeting full episode criteria.
• Symptoms present >50% of time; no symptom-free interval >2 months.
• No history of mania, major depression, or psychotic disorder.
• Not substance/medical induced.
• Clinically significant distress/impairment.

Symptom Profile

• Hypomanic: Elevated/irritable mood, increased energy, decreased sleep, grandiosity, talkativeness, racing thoughts, impulsivity.
• Depressive: Low mood, anhedonia, fatigue, sleep/appetite change, worthlessness, poor concentration.

Management

• Mood stabilizers (lamotrigine, valproate, lithium low-dose).
• Psychotherapy: CBT, IPSRT, psychoeducation.
• Lifestyle: regular sleep, stress management, avoid alcohol/drugs.
• Monitor for progression to bipolar I/II (~15–50% over lifetime).

Early recognition and treatment improve long-term trajectory.