Cyclothymic Disorder

Finding The Right Treatment

Treatment for cyclothymic disorder

Getting treatment for cyclothymic disorder can be a game changer for those who are struggling with this disorder. Without treatment, the experience of extreme emotional dysregulation will persist, and symptoms can intensify over time. In addition, the symptoms may escalate to the extent that the person eventually meets the criteria for bipolar disorder or major depressive disorder, and it is best to receive treatment prior to that time so that the disorder does not reach that level of dysfunction.

The good news is that most people with cyclothymia can improve dramatically with a combination of therapy, medications, and lifestyle modifications.

Finding a therapist

In addition to (or sometimes in lieu of) medications, psychotherapy has been proven to yield major improvements in the lives of those struggling. Therapists can intervene in many meaningful ways, including:

• Educating an individual (and their family) about the disorder
• Assessing one’s risk of self-harm or suicide
• Helping one to identify and challenge negative thought patterns and replace them with healthier, more adaptive thoughts and behaviors
• Working with an individual to re-build their self-esteem
• Exploring the impact of one’s symptoms on their work and home life, and developing strategies to mitigate these effects

By working with an individual to develop these insights and tools, a skilled therapist provides consistent support and helps individuals stay on track. Many individuals with cyclothymic disorder find therapy to be one of the best ways to prevent repeated episodes of emotional dysregulation.

Therapy can identify the triggers and signs of an oncoming episode, allowing therapists to intervene earlier. The natural ups and downs of life can often be triggers for these episodes, and a steadfast therapist can help an individual to weather these storms.

There are different kinds of professionals who can provide effective therapy, including:

• Clinical psychologists (PhD)
• Licensed clinical social workers (LCSW or LMSW)
• Licensed professional counselors (LPC)
• Licensed clinical professional counselors (LCPC)
• Licensed Marriage and Family Therapists (LMFT)

There are several styles of therapy that can be helpful for people with cyclothymic disorder, including psychodynamic, interpersonal, and supportive therapy. In recent years, more therapists employ cognitive behavioral therapy (CBT), which is a method that helps the individual identify unhelpful thought patterns, challenge distorted cognitions, and replace them with more constructive thinking. For those who have concerns with impulse control and self-destructive behaviors, dialectical behavioral therapy (DBT) is an approach that a growing number of clinicians have specialized training in.

The decision to start therapy

Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Medication for cyclothymic disorder

Medications can play a central role in the lives of many people with cyclothymic disorder. Finding the right medication is not always straightforward, as individuals metabolize and react to medications differently. Adjusting dosages to manage and prevent symptoms can be expected during the treatment process.

There are no medications that are approved by the Food and Drug Administration (FDA) for the treatment of cyclothymic disorder. However, physicians may prescribe medications off-label to treat the symptoms from which the person suffers, and often treatment is extremely effective.

Mood stabilizers

With cyclothymia, the first step is to try a mood-stabilizing medication used to treat bipolar disorder rather than a medication to treat depression. Antidepressants generally are not used because they may aggravate bipolar disorder-like symptoms.

Alternatively, antipsychotic medications may be prescribed off-label to treat the person’s symptoms of emotional dysregulation. In some cases, both a mood stabilizer and an antipsychotic may be prescribed.

Antipsychotic medications

There are many antipsychotics and most physicians prefer the newer “second generation” or “atypical” antipsychotics that are available today. These formulations are longer-acting than earlier drugs and also have a more favorable side effect profile than medications that were popular twenty years ago.

FDA warning about suicide risk with antidepressants

Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, please stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.

Dietary supplements

There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven. Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.