Cyclothymia in Children and Adolescents

Symptoms, Treatment and Outcomes

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Cyclothymic disorder, or cyclothymia, is a mood disorder in which a child experiences alternating episodes of hypomania and depressive symptoms. Cyclothymia is considered to be part of the bipolar disorder spectrum, with mild but chronic symptoms.

The Course of Cyclothymia

Cyclothymic disorder involves periods of depressive symptoms alternating with periods of hypomania, which is an elevated mood state.

In order to receive a diagnosis of cyclothymia, a child must experience symptoms for at least one year, with no more than two months free of symptoms.

The onset of cyclothymia typically begins in adolescence, although it may begin as early as childhood.

Although the rates of cyclothymia and other bipolar disorders in children and adolescents are not well established, the National Institute of Mental Health reports the rate of cyclothymia as approximately 1% in children, and as high as 3% in adolescents.

A family history of bipolar or cyclothymic disorder is a risk factor for developing cyclothymia. Some research suggests that cyclothymia is a risk factor for developing bipolar II disorder.

Symptoms of Cyclothymia

Symptoms of cyclothymia are considered to be mild enough to function. However, a child often experiences significant impairment in important areas of daily functioning.

Symptoms of cyclothymia may include:

  • Irritability
  • Short or quick temper
  • Very little or no sleep, but not feeling tired
  • Easily distracted
  • Lack of concentration
  • Overly joyful
  • Recurring thoughts of death or suicide
  • Fast speech
  • Racing thoughts
  • Difficulty completing a task
  • Engaging in excessive reckless behavior, such as fast driving, overspending, substance abuse, etc.

    Children or teens with cyclothymia may be described as unreliable, moody, or temperamental because of unpredictable or irritable moods.

    For a diagnosis of cyclothymia, the depressive symptoms must not meet the criteria for a major depressive episode, and the hypomanic symptoms must not meet the criteria for mania. Additionally, symptoms must not be better explained by substance use or another psychiatric or medical illness.

    Treatment Options for Cyclothymia

    Once a child is evaluated and diagnosed, her physician will consider all factors of her situation and determine the most appropriate treatment for her.

    Mood stabilizing medications, like lithium and mood-stabilizing anticonvulsants, are known to be effective for bipolar disorder in children and adolescents. Psychotherapy has also been shown to be an effective accompanying treatment.

    Antidepressant medications may be prescribed, but need to be used cautiously in children and adolescents with a family history of bipolar disorder, as they can potentially contribute to manic episodes or increased mood cycling.

    Outcomes of Cyclothymia

    Even though cyclothymia is considered to be a chronic disorder, appropriate treatment can significantly help manage symptoms. Without treatment, however, short- and long-term consequences associated with cyclothymia are:

    • Low self-esteem
    • Interpersonal relationship difficulties
    • Substance use and abuse
    • Academic decline
    • Increased risk for suicide attempt

    Less than half of people with cyclothymia end up developing bipolar disorder and in some people, cyclothymia actually disappears with time.

    When to Seek Help

    If your child or adolescent has symptoms of cyclothymia or another bipolar disorder, talk to her pediatrician or a mental health professional. Cyclothymia is a serious medical illness that requires treatment. Treatment can significantly reduce the severity of symptoms and potentially prevent future episodes.

    Sources:

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: American Psychiatric Association: 2000.

    Bipolar Disorder in Children. National Institute of Mental Health. Accessed: March 01, 2011. 

    Gabrielle A. Carlson. Annotation: Child and Adolescent Mania - Diagnostic Considerations. Journal of Child Psychology and Psychiatry. 1990; 31(3): 331-341.

    How Is Bipolar Disorder Detected in Children and Teens? The National Institute of Mental Health. Accessed: March 08, 2011. 

    Jim Rosack. Bipolar Disorder Often Misdiagnosed In Children, Expert Says. Psychiatric News, July 5, 2002 37(13): 26.

    Press Release: Rates of Bipolar Diagnosis in Youth Rapidly Climbing, Treatment Patterns Similar to Adult. September 03, 2007. National Institute of Mental Health. Accessed: 02/14/2011. http://www.nimh.nih.gov/science-news/2007/rates-of-bipolar-diagnosis-in-youth-rapidly-climbing-treatment-patterns-similar-to-adults.shtml

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