What is cyclothymia (mood swings)?
Cyclothymia is a mental affective disorder in which the patient experiences mood swings between indistinct (close to dysthymic) depression and hyperthymia (sometimes there are even episodes of hypomania).
These disorders are chronic and usually intermittent. Individual episodes are not deep enough to qualify as hypomania or mild depression. Last for years, and sometimes throughout the life of the patient. Due to this, they resemble special personality disorders such as constitutional cycloids or constitutionally depressive ones. Life events and stresses can deepen these conditions.
What provokes / Causes of Cyclothymia (mood swings)
The etiology of chronic mood disorders is both constitutional-genetic and due to a special affective background in the family, for example, its orientation towards hedonism and optimism or a pessimistic perception of life. When confronted with life events that none of us manage to avoid, the personality reacts with a typical affective state, which initially seems quite adequate and psychologically understandable. This affective state, although it causes the reaction of others, but it seems to them adaptive.
Symptoms of Cyclothymia (mood swings)
Often since childhood or adolescence, mood swings of a seasonal type are noted. However, this diagnosis is considered adequate only in post-puberty, when unstable mood with periods of subdepression and hypomania lasts at least two years. The clinic itself is endogenously perceived only as a period of inspiration, rash acts or blues. Moderate and severe depressive and manic episodes are absent, but are sometimes described in the anamnesis. The period of depressed mood grows gradually and is perceived as a decrease in energy or activity, the disappearance of the usual inspiration and creativity. This in turn leads to a decrease in self-confidence and feelings of inferiority, as well as social isolation, isolation is also manifested in reduced talkativeness. Insomnia appears, pessimism is a stable property of character. The past and the future are evaluated negatively or ambivalently. Patients sometimes complain of increased drowsiness and impaired attention, which prevents them from absorbing new information. An important symptom is anhedonia towards previously enjoyable instinctual discharges (eating, sex, travel) or pleasurable activities. A decrease in activity is especially noticeable if it followed an elevated mood. However, there are no suicidal thoughts. The episode can be perceived as a period of idleness, existential emptiness, and when it is long, it is evaluated as a character trait. The opposite state can be stimulated by endogenous and external events and also be tied to the season. With an elevated mood, energy and activity increase, and the need for sleep decreases. Creative thinking increases or sharpens, this leads to an increase in self-esteem. The patient tries to demonstrate intelligence, wit, sarcasm, speed of association. If the patient’s profession coincides with self-demonstration (actor, lecturer, scientist), then his results are rated as “brilliant”, but with a low mind, increased self-esteem is perceived as inadequate and ridiculous. Interest in sex increases and sexual activity increases, interest in other types of instinctive activities increases (food, travel, there is an over-involvement in the interests of one’s own children, relatives, an increased interest in outfits and jewelry). The future is perceived optimistically, past achievements are overestimated. The psychological analogue of cyclothymia is the creative productivity of A.S. Pushkin, which, as you know, was characterized by significant productivity in the fall and a decrease in the activity of inspiration in the spring. The same periods of creative productivity, covering a longer period, were characteristic of P. Picasso. Cyclic mood rhythms clearly depend on the length of daylight hours, the latitude of the area, this is intuitively captured by patients in their desire for migration and travel.
Diagnosis of cyclothymia (mood swings)
- More than two years of unstable mood, including alternating periods of both subdepression and hypomania, with or without intervening periods of normal mood.
- There are no moderate and severe manifestations of affective episodes for two years. Observed affective episodes are lower in level than mild ones.
- In depression, at least three of the following symptoms must be present:
– decreased energy or activity;
– insomnia;
– decreased self-confidence or feelings of inadequacy;
– difficulty concentrating;
– social isolation;
– decreased interest or pleasure in sex or pleasurable activities;
– decreased talkativeness;
– a pessimistic attitude towards the future and a negative assessment of the past. - An increase in mood is accompanied by at least three of the following symptoms:
– increased energy or activity;
– reduced need for sleep;
– increased self-esteem;
– heightened or unusual creative thinking;
– increased sociability;
– increased talkativeness or demonstration of the mind;
– increased interest in sex and increased sexual relations, other activities that give pleasure;
– over-optimism and reassessment of past achievements.
Individual anti-disciplinary actions are possible, usually in a state of intoxication, which are rated as “excessive fun”.
Differential Diagnosis
It should be differentiated from mild depressive and manic episodes, bipolar affective disorders occurring with moderate and mild affective attacks, hypomanic states should also be distinguished from the onset of Pick’s disease.
In relation to mild depressive and manic episodes, this can usually be done on the basis of anamnesis data, since unstable mood in cyclothymia should be determined for up to two years, suicidal thoughts are also not characteristic of cyclothymics, and periods of elevated mood are socially more harmonious. Cyclothymic episodes do not reach the psychotic level, which distinguishes them from affective bipolar disorders, in addition, cyclothymics have a unique anamnestic history, episodes of mood disturbances are noted very early in puberty.
Mood changes in Pick’s disease occur late in life and are associated with more severe impairments to social functioning.
Treatment for cyclothymia (mood swings)
Prevention of episodes of disturbed mood in cyclothymia is carried out with lithium, carbamazepine or sodium valproate. These same drugs can be used in the treatment of elevated mood, although in cases where it is accompanied by increased productivity, this is hardly advisable. For depressed mood, Prozac, sleep deprivation treatment, and enotherapy are indicated. Sometimes the effect is given by 2-3 sessions of nitrous oxide, amytal-caffeine disinhibition and intravenous administration of novocaine.