Cyclothymia in Children and Adolescents

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.

This article discusses the course that cyclothymia takes, including its onset and potential for developing into bipolar disorder. It also explores the symptoms of the condition, treatments that are available, and steps that parents and caregivers can take to help their child.

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.

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:

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

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, their physician will consider all factors of their situation and determine the most appropriate treatment for them. There is no cure for cyclothymia in children and teens, but there are treatments that can help manage symptoms.

Medications

Medications are often the first-line treatment for bipolar disorder in both children and adults. Such medications work by helping to stabilize moods.

• Mood stabilizing medications, like lithium and mood-stabilizing anticonvulsants, are known to be effective for bipolar disorder in children and adolescents. Such medications are often effective but may have potential side effects that you should discuss with your child's doctor.
• 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.

All antidepressants carry an FDA black-box warning about an increased risk of suicidal thinking in children and young adults. Because of this potential risk, children should be carefully monitored by their parents and doctors to watch for warning signs of suicide.

Psychotherapy

Psychotherapy has also been shown to be an effective accompanying treatment. Therapy can help children learn to recognize the signs that are experiencing symptoms of depressive or manic episodes. Children can also work on developing coping skills that will help them better manage symptoms.

Cognitive behavioral therapy (CBT) is a type of therapy that can help children and teens with cyclothymia learn to recognize unhelpful or negative thought patterns and behaviors that might contribute to mood episodes.

When to Seek Help

If you are concerned about symptoms or behaviors that your child is exhibiting, talk to their pediatrician for further evaluation. Changes in mood, activity levels, behaviors, academic performance, social behavior, and sleep patterns can all be cause for concern.

Talk to their pediatrician or a mental health professional if your child or adolescent has symptoms of cyclothymia or another bipolar disorder. Cyclothymia is a serious medical illness that requires treatment.

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:

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

How Parents Can Help Children With Cyclothymia

If your child has been diagnosed with cyclothymia or another mental health condition, there are steps you can take to offer support and help your child manage their symptoms. Some actions you can take:

• Be patient and understanding with your child. Encourage them to talk to you about what they are experiencing.
• Pay attention to your child's moods and behaviors to watch for changes that might indicate a mood episode.
• Recognize your child's triggers and take steps to manage changes in mood.
• Help your child adhere to their treatment plan. It takes time for therapy and medication to work, so consistency is important. 
• Help your child manage stress. Stress can make symptoms worse and more difficult to manage, so minimizing sources of stress and relying on relaxation strategies can be helpful.