Some weeks everything flows. You sleep five or six hours and wake up raring to go, you talk to everyone, you jot ideas down on your phone and say yes to every plan. Then, without anything serious having happened, the dip arrives: getting started is hard, the things that excited you no longer mean anything and you cancel what you had promised. It is not intense enough for anyone to mention depression, and the highs are too enjoyable to see as a problem. So you put it down to your personality.

When that back-and-forth goes on for years, it has a name: cyclothymia. It is a mood disorder milder than bipolar disorder, but steady enough to wear down your work, your relationship and the way you see yourself. This guide explains what it is, what the symptoms of cyclothymia are, how it differs from bipolar disorder, what it gets confused with and which test can help you make sense of what is happening before you seek advice.

What is cyclothymia?

Cyclothymia, also called cyclothymic disorder, is a pattern of high and low periods that alternate for years without ever reaching the intensity of a full episode of mania or depression. The NHS describes it as a mild form of bipolar disorder, and MedlinePlus, the health information service of the US National Library of Medicine, describes it in the same way: mood swings that range from mild depression to emotional highs.

Mild does not mean harmless. The NHS explains that many people do not seek help because their symptoms are mild or because the highs feel nice, which is why cyclothymia often goes undiagnosed and untreated. A review by Van Meter, Youngstrom and Findling, published in 2012 in Clinical Psychology Review, points out that the disorder has been in the DSM, the American psychiatric diagnostic manual, since 1980, that it is rarely diagnosed in clinical practice and that, even so, there is evidence it may be the most common form of the bipolar spectrum.

Cyclothymia, personality and temperament

Plenty of people describe themselves as moody, and that alone is not a disorder. Part of the problem is that the line is blurred. The Van Meter review itself acknowledges that cyclothymia overlaps, in terminology and in symptoms, with temperament and with personality disorders. A team from Pisa and Paris led by Perugi goes further and suggests understanding it as an exaggerated form of cyclothymic temperament: a way of reacting very intensely and very quickly to both good and bad things.

In other words, not everyone with ups and downs has cyclothymia. What turns it into a clinical problem is that the changes keep coming back with hardly a break, for years, and end up taking their toll.

Symptoms of cyclothymia

The symptoms of cyclothymia come in two kinds, highs and lows, which alternate with each other and with periods of normal mood.

The highs: mild hypomania

According to the NHS, during the high phases you feel very happy and excited, need less sleep, are more sociable and more impulsive and feel you have a lot of energy. They are not always experienced as euphoria. The Perugi review notes that in people with cyclothymia, hypomania mostly shows up as irritability, disinhibition and impulsiveness rather than elation. It is the season of snapping at people, starting three things at once and making decisions that a week later make no sense to you.

The lows: low mood that falls short of depression

During the low phases you may feel flat, sluggish and uninterested in almost everything. The difference from depression is one of degree: the NHS makes clear that these lows do not last long enough and are not severe enough to be diagnosed as depression, and that they should not stop you going about your daily life. MedlinePlus sums it up by saying that these mood swings are less severe than those of bipolar disorder or major depression.

How long the ups and downs last

What defines cyclothymia is not intensity but persistence. The NHS says that mood swings are fairly frequent, to the point that you do not go longer than two months without a low or a high, and that it can be diagnosed when symptoms have lasted at least two years, or one year in children and teenagers.

How it shows in daily life

Often other people notice it before you do. Perugi and colleagues describe how people with cyclothymia react to good news with instant enthusiasm and to a setback, even a small one, with a disproportionate slump. They also describe them as very sensitive to criticism and rejection, a sensitivity that goes hand in hand with marked swings in self-esteem. The NHS adds that mood swings can affect daily life and cause problems with personal and work relationships. If you recognise yourself in that way of reacting, you may want to read Emotional regulation: what it is, why it sometimes fails and how it is learned.

Cyclothymia and bipolar disorder: how they differ

Cyclothymia is part of the bipolar spectrum, but it is not the same as type I or type II bipolar disorder. The difference lies mainly in intensity:

Cyclothymia Bipolar disorder
Highs Hypomanic symptoms that do not add up to a full episode Episodes of mania (type I) or of hypomania lasting four days or more (type II)
Lows Low mood that does not reach major depression Major depressive episodes, required for type II and very common in type I
Time Almost continuous ups and downs for at least two years (one in children and teenagers) One manic episode is enough (type I), or one hypomanic and one major depressive episode (type II)
Daily life You can keep up your routine, though with distress and friction Mania and major depression clearly disrupt work, relationships or health

This table is no substitute for a diagnosis, but it helps explain why some people with cyclothymia go for years without anyone putting a name to what is happening to them: none of their highs or lows, taken on its own, seems serious enough.

Can cyclothymia turn into bipolar disorder?

It can, and the sources describe it with different nuances. MedlinePlus says that less than half of people with cyclothymic disorder go on to develop bipolar disorder and that, in the rest, cyclothymia continues as a chronic condition or disappears with time. The NHS is more cautious: it says it is not known how many people with cyclothymia will develop full bipolar disorder, that some see their highs or lows become more severe and that others live with it as a lifelong condition. That is why one of the aims of treatment is precisely to stop it developing into full bipolar disorder.

Causes of cyclothymia

They are not fully known. The NHS points to a probable genetic link, because cyclothymia, depression and bipolar disorder tend to run in families, and explains that in some people a traumatic experience, a serious illness or a long period of stress can act as a trigger. MedlinePlus notes that it usually begins early in life and affects men and women equally, although, as the NHS points out, it can start at any age.

If you have relatives with depression or bipolar disorder and you recognise yourself in this pattern, it is worth mentioning when you seek help.

What cyclothymia is confused with

Many things cause ups and downs, and not every change of mood is cyclothymia. These are the most common mix-ups:

  • Normal ups and downs. Everyone has better and worse days. Feeling elated after good news or crushed after a break-up is not cyclothymia; what defines it is ups and downs that keep coming back with hardly a break for years and cause you problems.
  • Depression. This is the most common mix-up. Perugi and colleagues note that many people with cyclothymia seek help only for the lows, barely aware of their high phases, because what weighs on them most is depression or anxiety. If your lows mix nerves and sadness, have a look at Anxiety or depression: how to tell them apart and what to do if you have both.
  • Borderline personality disorder. It shares emotional reactivity and sensitivity to rejection with cyclothymia. As a rough guide, in borderline personality disorder mood changes usually last hours, are closely tied to conflict or fear of abandonment and come with a chronic feeling of emptiness; in cyclothymia, the highs bring changes in sleep and energy, such as sleeping little without feeling tired. Even so, the line is so blurred that Perugi goes as far as writing that the distinction lies more in the clinician's eye than in real differences.
  • ADHD. Impulsiveness, restlessness and distractibility look similar, but in ADHD they are stable traits from childhood that do not come and go in phases. The two can coexist. If distractibility and impulsiveness have been with you for as long as you can remember, the ADHD Test will help you find out.
  • Physical causes and substances. MedlinePlus explains that diagnosis is usually based on your mood history and that blood and urine tests may be ordered to check for medical causes of mood swings. Alcohol and other drugs can also cause similar highs and lows.

Is there a cyclothymia test?

No online test can diagnose cyclothymia. A professional makes the diagnosis based on your history: when the ups and downs started, how long they last, what happens during the highs and the lows, and whether there is a family history. What a questionnaire can do is help you organise that history and decide whether it is worth getting it checked.

That is what the MyPsicoTest Bipolar Disorder Test is for: it is a screening questionnaire for the bipolar spectrum. It has 16 questions about your whole life, not just the last few weeks, takes about five minutes and covers three areas:

  • Episodes of elation, energy and irritability: sleeping much less without feeling tired, talking more and faster, racing thoughts, impulsive spending or decisions.
  • Depressive episodes: spells of sadness, loss of interest, tiredness or hopelessness.
  • Alternation and impact: whether the changes happen at the same time, whether highs and lows alternate, whether others notice and whether they have caused you problems.

The score ranges from 0 to 64 and falls into four bands, from "few indicators" to "high indicators". You do not need to sign up, and your answers are not sent to any server.

How to read your result if you suspect cyclothymia

The test has no band called "cyclothymia", because it is not designed to separate one form of the bipolar spectrum from another. But the detail of your result offers clues. Look at the breakdown by area: as the test itself says in the "some indicators" band, if the elation area scores high and you have also indicated that the changes coincide in time, it is worth discussing with a professional even if your total is not very high. And if you scored in all three areas, take the result to your appointment and mention cyclothymia as one of the possibilities you want to rule out.

A mood diary to take to your appointment

Woman writing down her mood, hours of sleep and energy in a notebook to spot cyclothymia cycles

Another recommendation from the test is especially useful with cyclothymia: keeping a daily mood diary for a few weeks, with your mood, hours of sleep and energy level, which is the most useful tool for spotting cycles. A notebook or a note on your phone and one minute each evening are enough:

  • How your mood has been, on a simple scale from very low to very high.
  • How many hours you slept.
  • How much energy you had and whether you were more irritable than usual.
  • Whether anything important happened that day.

After a few weeks the pattern usually speaks for itself, and it is exactly what a professional needs to see. If you can, also ask someone you trust to describe how you seem during your "up" spells: the test points out that an outside view is very valuable for diagnosis, and with cyclothymia even more so, because the highs are the part people remember least.

Other tests that complete the picture

Since the lows are usually what weighs most, the Depression Test will help you see how you are right now. And because irregular sleep is one of the most common triggers of mood changes, the Insomnia Test will tell you whether your sleep needs attention. All the questionnaires, free and anonymous, are in the psychological tests catalogue.

Treatment for cyclothymia

Cyclothymia can be treated. According to the NHS, treatment usually involves some kind of talking therapy and, in some cases, medicines, with three aims: reducing symptoms, stopping them coming back and stopping cyclothymia from developing into full bipolar disorder.

  • Psychotherapy. The NHS mentions cognitive behavioural therapy (CBT), which helps you manage symptoms by changing the way you think and behave, with practical tools for everyday life.
  • Psychoeducation. Perugi and colleagues stress that understanding how your own temperament works should be part of treatment from the start. They describe a group programme created in Paris by Hantouche and colleagues, with six weekly sessions covering mood monitoring, warning signs, routines, sensitivity to rejection, emotional dependency and conflicts with others, with promising preliminary results.
  • Medicines. Mood stabilisers are prescribed and supervised by a psychiatrist. The NHS makes clear that not everyone with cyclothymia needs them or responds to them, and MedlinePlus adds that some people with cyclothymia may not respond as well to medicines as people with bipolar disorder.
  • Routines. Keeping regular sleep times and going easy on alcohol and other substances helps stop the ups and downs from spiralling.

If thoughts of harming yourself appear during the lows, do not wait for a diagnosis: in immediate danger, call 112 or your local emergency number, and in Spain the 024 line is free, confidential and available 24 hours a day.

The first step can be as simple as taking the test and bringing the result, together with your mood diary, to your GP or a psychologist. At the end of the test you will find our recommendation of a licensed psychologist who also works online.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: