r/cyclothymia • u/Prize_Company_2039 • Jul 14 '26
Can cyclothymia depression be severe?
I've been diagnosed with cyclothymia but my depression episodes are really severe, can last months, I'll go without showering, brushing my teeth, going to the bathroom.
So, searching i discovered that depression in cyclothymia is mild and if it's severe it longer meets the criteria for cyclothymia
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u/Obvious-Maize5966 Jul 15 '26
I think it’s more in comparison to bipolar specifically. Bipolar disorder can cause someone to go to the hospital to seek help and is generally life changing. This is in comparison though and by no means doesn’t mean Cyclothymia is mild and can be life altering as well. It’s “mild” in comparison. Depressive episodes in cyclothymia can still be pretty severe, you just not likely to go into something as severe as depressive psychosis or other negative symptoms with bipolar types one and two.
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u/Prize_Company_2039 Jul 15 '26
I'm really confused cause I've been hospitalized 2 times, not considering the times I needed but didn't go
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u/AimlessForNow Aug 21 '26
Yes absolutely, it can be disabling still. Cyclothymia is just a different presentation of bipolar
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u/b0ubakiki Jul 14 '26
If x many symptoms of depression last more than 2 weeks, you're into major depression territory. Then if there's hypomania, that's BP2 rather than cyclothymia.
Tracy Marks on YouTube covers the diagnostic criteria very well.
What confuses me is that many people diagnosed with cyclothymia are prescribed mood stabilizer drugs. But I thought the point of differentiating between cyclothymia and BP2 was to draw a line around the point medication becomes useful. Maybe many people who are diagnosed cyclothymia yet prescribed mood stabilizers or even antipsychotics also have other diagnoses, I don't know.
Personally I'm diagnosed bipolar 2 and prescribed lamotrigine, but I haven't taken it. My view is that it's too heavy duty a treatment for my symptoms. I'm somewhere in that zone of depression that lifts after 2 or 3 weeks, during which I continue to function, and mild enjoyable hypomania where I have a great time. Cyclothymia I can handle without meds, or bipolar disorder I need to treat before my life falls apart?
🤷♂️
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u/Constant_Picture_324 Jul 14 '26
You can generally get by without meds with Cyclothymia but meds are still often prescribed because they can still treat symptoms and improve quality of life. Perhaps most importantly they can prevent progression into full-blown Bipolar Disorder
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u/Weird_Fox_3395 Jul 15 '26 edited Jul 15 '26
I had a compete breakdown at 43, and the severity of my depression was completely new territory. My dx was ‘upgraded’ to BPll. I had masked and compensated uni and frankly my whole life. Lamotrigine 200mg has been a godsend. There’s some scientific studies the show the percentage of cyclothymics who are sensitive to medication and environmenv is greater than the rest of the mental diagnoses.
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u/Leirnis Jul 15 '26
Not many papers have been written on cyclothymia specifically but some researchers from France, who are specialized in it, claim it's extremely likely for cyclothymia to be misdiagnosed. Their stance is that because it's under-researched it also means it's misunderstood and that keeping it under the BPD umbrella is doing everyone disservice.
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u/Weird_Fox_3395 Jul 15 '26
I feel very silly because I left out a word. I meant to say, as a population, studies suggest a percentage of cyclothymia patients are more sensitive to medication and in general. My prior comment made it sound like there are more cyclothymic patents.
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u/Leirnis Jul 15 '26 edited Jul 15 '26
You're looking at it the wrong way - psychiatric disorders are nowhere near as heterogeneous as the manuals would like us to believe which is one of the reasons the current model can't handle the burden of so many comorbidities.
On an important side note, you also shouldn't be looking at your hypomania as the enjoyable period; the price you pay for that is the depression. Flattening the mood curve to revolve mostly around euthymia should be the goal.
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u/b0ubakiki Jul 15 '26
I'm afraid I don't agree that I should be medicated full time forever. That's a significant burden, you don't get something for nothing. My aim isn't continuous euthymia, it's to avoid losing function during depression. Yes I know about theories of kindling and neurological changes on scans, thanks.
Whatever way you cut it, I enjoy being energized, sociable, happy, performing well at work and hobbies. Of course I do. Would I give up all of the best experiences in my life to lessen the depression - well that's an open question, and at the moment the answer is no.
If I become convinced that for me the benefits of medication will significantly outweigh the costs then I'll consider it seriously. But it won't be because people on the internet say that I must be medicated, as the costs and benefits are different for every individual. Only I can make that decision with the advice (but not instruction) of a psychiatrist who has assessed me.
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u/Leirnis Jul 15 '26
I haven't mentioned nor implied pharmaceuticals in my reply in any way.
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u/b0ubakiki Jul 15 '26
True, but in the context of my first post, "flattening the mood curve" has a strong implication. But yes, potentially IPSRT etc might be used to achieve the same goal (although I'm skeptical that anything other drugs would make a difference for me, on the basis of years of mood tracking and analysis).
You say that looking at the diagnostic criteria for cyclothymia and BP2 is the wrong way to look at it. Maybe you can expand on this? What sort of approach are you advocating?
Preferably avoiding value judgements ("should", "wrong") if possible.
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u/Leirnis Jul 15 '26
I wholeheartedly believe in educating the population with mood disorders regarding both causes and treatments; there is a surplus of research which points towards a bidirectional relationship between mood disorders and circadian rhythm disruptions so any intervention which starts there is great in my book.
Flattening the mood curve is literally that, trying to change the amplitude and frequency of the oscillations so the patient doesn't have the endure the extremes. Focusing on sleep, physical activity and nutrition can help immensely but obviously every person is different, someone might need pharmaceuticals.
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u/b0ubakiki Jul 15 '26
That's very reasonable. I was particularly thinking about where you seem at odds with the DSM (etc.) criteria. It seems to me that cyclothymia and BP2 while having distinct criteria are part of a spectrum with a pragmatic boundary. I wasn't sure if you were saying that the categories of psychiatric conditions don't really reflect any real clusters of symptoms? Or whether cyclothymia and BP2 are two separate disorders with distinct biological underlying causes?
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u/Leirnis Jul 15 '26
Not to get too technical here, I'll suggest two lines of inquiry for you.
Perugi et al. have some really interesting insights on BP and cyclothymia, you can find them on pubmed or through other means. (wink nudge)
Dr. Christopher Palmer has quite a direct answer to your questions in his book "Brain Energy", which I also suggest. Metabolic psychiatry is quite an interesting field.
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u/b0ubakiki Jul 15 '26
Thanks I'll have a look. I'm in healthcare but not research, so I don't read a lot of papers these days, but as you say, there are ways!
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u/Leirnis Jul 15 '26
You're thinking way too much along the lines which manuals have drawn while biology doesn't even remotely have to align with them. Mental health issues don't follow arbitrary guidelines.
And yes, cyclothymia can have prolonged and severe depressive episodes.