Diagnostic criteria for 301.13 Cyclothymic Disorder
( cautionary statement )

Cyclothymic Disorder is a chronic bipolar disorder consisting of short periods of mild depression and short periods of hypomania. These symptoms may last a few days to a a number of weeks. The onset is separated by short periods of normal mood. Individuals with cyclothymia are never totally free of symptoms of either depression or hypomania for more than a number of months at a time. Diagnostic criteria is as follows:

A. For at least 2 years, the presence of numerous periods with hypomanic symptoms (see p. 338) and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode . Note: In children and adolescents, the duration must be at least 1 year. 

B. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time. 

C. No Major Depressive Episode , Manic Episode , or Mixed Episode has been present during the first 2 years of the disturbance. 

Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed). 

D. The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia , Schizophreniform Disorder , Delusional Disorder , or Psychotic Disorder Not Otherwise Specified. 

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism). 

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Associated Features:

Euphoric Mood
Depressed Mood
Somatic or Sexual Dysfunction
Hyperactivity
Addiction
Odd or Eccentric or Suspicious Personality
Dramatic or Erratic or Antisocial Personality

Differential Diagnosis:

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

Psychiatric:

Mood Disorder Due to a General Medical Condition; Substance-Induced Mood Disorder; Bipolar I Disorder, With Rapid Cycling; Bipolar II Disorder, With Rapid Cycling; Borderline Personality Disorder.

Medical:

Organic Mood Syndromes caused by: Acquired Immune Deficiency Syndrome (AIDS), Cushing's Disease, Epilepsy, Fahr's Syndrome, Huntington's Disease, Hyperthyroidism, Premenstrual Syndrome, Migraines, Multiple Sclerosis, Neoplasm, Postpartum, Stroke, Systemic Lupus Erythematosus, Trauma, Uremia, Vitamin Deficiency, Wilson's Disease.

Drugs:

Amphetamines, Antidepressants (treatment or withdrawal), Baclofen, Bromide, Bromocriptine, Captopril, Cimetidine, Cocaine, Corticosteroids (including ACTH), Cyclosporin, Disulfiram, Hallucinogens (intoxication and flashbacks), Hydralazine, Isoniazid, Levodopa, Methylphenidate, Metrizamide (following myelography), Opiates, Procarbazine, Procyclidine, Yohimbine.

Mood Disorder Episodes: | Major | Manic | Mixed | Hypomanic |

Cause:

Genetic factors appear to be causative in Cyclothymia as they do in the Bipolar Disorders. Many of those affected have a family history of major depression, bipolar disorder, suicide or alcohol/drug dependence.

Treatment:
In some cases individuals may prefer no treatment or supportive psychotherapy alone. Lithium, a mood stabilizer used commonly in the treatment of Bipolar Disorder, has been proven to help a substantial number of people with Cyclothymia.

Counseling and Psychotherapy:

Couples or Family therapy is often sought to help with the problems in relationships brought on by the disorder.

Pharmacotherapy:

Biomedical treatment of cyclothymic disorder should be empirically derived and should be offered only if the individual's functioning is significantly adversely affected.

Antimanic Drugs.
Lithium Carbonate.
Carbamazepine (Tegretol).
Valproic Acid (Depakene, Depakote).
Verapamil (Calan)