Cyclothymia: Bipolar’s baby sibling

Cyclothymia is one part of the bipolar spectrum that I don’t understand. Everyone that I have encountered with it is someone I would say had suffered a major depressive episode, which would change their diagnosis to Bipolar II. However, the medical establishment has a different definition of major depression than I do. Again, whereas people think it’s easy to be diagnosed with a mental illness, it is actually extremely difficult. Major depression, or severe clinical depression, is diagnosed far less frequently than mild or moderate depression. Major depression is the kind of crippling, in bed, want to sleep, can barely function depression. It’s a depression that I would have been diagnosed with only a few times in my life. My depressions nearly always involve an element of mania, so my most frequent episodes are mixed ones. Most of the time, when I am “normal”, I have mild or moderate depression or mild to moderate hypomania.

I have wondered if I ever did have cyclothymia, as 30% of cyclothymic types go on to develop bipolar I or II. Thinking back, I don’t think I have. My first big episodes were major depression followed by severe mania. Before rapid-cycling kicked in, I was almost a cartoon character of a manic depressive. And so it began.

Cyclothymia is defined as “bipolar-lite”; a constant flux of mood that pursues a chronic course. The moods range from mild depression (dysthymia) to mild elation (hypomania). Symptoms persist, and the longest the person is symptom free is no more than two months. This form of bipolar disorder is the classic “moody” type, with mood swings occuring naturally much faster than those in Bipolar I and II (ultra and ultradian cycling excepted). Cyclothymia is also a bit of a measuring pole with which someone who doesn’t have bipolar disorder can see how severe an illness it is. Cyclothymia is bipolar’s baby sibling, and yet it’s a treacherous enough illness even without the bipolar association.

This is the DSM-IV diagnostic criteria:

1. Individual has had many periods of both hypomania and depression, for a period of at least 2 years.

2. Individual has experienced no periods of normal mood lasting longer than two months.

3. Individual has experienced no major depression, manic or mixed episode

4. Symptoms are not attributable to either Schizophrenia or Psychotic Disorder

5. Symptoms are not due to effects of medication, illicit drugs or medical condition.

6. Individual experiences significant distress or impairment in daily living.

It has always confused me. Stephen Fry is apparently cyclothymic, but someone who locks themselves in a garage with the intention to gas themselves to death doesn’t strike me as someone who has “mild” depression. So what is it actually like to have cyclothymia?

McMan, as usual, is helpful:

Diane would soon learn that this was just a taste of things to come. Twice in the next months Mark lost excellent jobs, once because he was unable to get out of bed for several days and failed to call in and once because he decided he knew better than his boss. When he was depressed he was disinterested in working and gave no thought to finances. Diane worried about the bills and he would be angry if she tried to talk to him. Then before she knew it he was on top of the world. At such times he was wonderful with her, but Diane felt she was a ship at sea without an anchor. She never knew what to expect.

Neither did Mark. He was as much at mercy to his moods as Diane was. Yet, he couldn’t truly understand why she was so upset. Mark didn’t see anything aberrant about his moodswings – he had had them for years and thought it was normal for people to go through them.

Things came to a head one night when Mark arrived home, escorted by two police officers and charged with DUI. Diane gave him an ultimatum. Either they seek help or she was leaving him.

The bolded part of the passage is something I suspect a lot of people think about their moodswings; I certainly did. I thought that what I went through was normal and that there was no need to worry. And although cyclothymia is allegedly mild, I don’t see anything that is “lite” about it. Given that most people with bipolar disorder do have periods of normality in between episodes, cyclothymia seems rather cruel.

There is almost a saving grace of the big, bad bipolar I and bipolar II. There is usually a time when the episodes are extreme. And extreme episodes are almost easier to understand as madness. Those around you will know that you have misplaced your marbles. Mild episodes, however, might feel to those around them as annoyances rather than something to worry about.

Treatment for cyclothymia is psychotherapy and/or a low dose mood stabiliser. Unlike the other forms of bipolar, those with cyclothymia don’t have to take medication and can opt for therapy instead, rather than as adjacent to. I am not sure how wise this is. If one has a genetic or biological cause, then why not the other?

Something I haven’t discussed here before is family history. Bipolar disorder is supposed to have a genetic link. If one sibling is affected, for example, there is a higher than average chance that another will be. More often than not, there is a family history of disorders such as depression, psychosis, schizophrenia, eating disorders and substance abuse disorders. All but one of these things are present in my immediate family so it isn’t that much of a big whoop that I am manic depressive. The rest of my family have problems with depression especially; my mother also has/had problems with psychosis, rage and a rather amazing capacity to lie at every opportunity, about every single thing.

Speaking of baby siblings…

The genetic element is one of a million reasons why I will probably not have children. I am afraid of passing this on to someone else. There are other reasons, as I said. My body doesn’t work properly anyway, I don’t have periods. I take Depakote (sodium valproate) which damages the unborn child. Depakote is the only thing I have taken so far that has even dented my mania so, with having to come off it during pregnancy, I would likely become psychotic. (Many manic depressive women do become psychotic during pregnancy. It is rare in those without manic depression, who will more likely experience deperssion). Seeing the pregnant woman in hospital just put the fear of god into me.

I am very afraid of psychosis. Yes, I have had positive experiences with it. Believing I was a genius, for example and having voices telling me so. And sometimes having bright hallucinations of light and beauty, hearing wonderful music and being inbued with a magical self belief. But those days are long gone, and most of my voices are threatening and frightening, most of my delusions are paranoid and most of my hallucinations are of things that mean to hurt me.

There’s also practical aspects. I’m terrified of having to explain my scars to a child. I am notoriously bad at holding down jobs. And, oh, I don’t have a boyfriend.

I do want children but my common sense tells me it’s a bad idea. Adoption, naturally, is out of the question. There are a million better mothers out there without severe mental illness, I wouldn’t stand a chance. Children are taken away from people like me, not given to them.

It was with immense sadness that all this dawned on me. I knew from when I was fifteen (and my periods stopped for four years) that my body was not up to the task of pregnancy. However, it didn’t even occur to me that I may not also be mentally up to the challenge. Now with an official diagnosis of severe mental illness, those words define who I am in the eyes of authority; bosses, doctors, adoption agencies, social services; and I can’t ever escape from it. The violent streak in my mania is no great help either. (Being manic I have trashed stuff, set things on fire, gotten into physical fights and hurled abuse at people). I have been warned many times by psychiatrists about the dangers of pregnancy, and I am not allowed to take my medication while trying to have a child.

If I did have a child and it developed cyclothymia, I wouldn’t feel as though they had some lucky escape from bipolar. I know too well how these things escalate; I would just have to try my best to make sure it didn’t happen.

I’ve always wondered what I would be like as a mum. I would love the child. Boy, girl, it wouldn’t matter. I thought I’d be quite a hippyish mother, since I am secretely rather hippyish. I’d teach it to read before it started school and take them for walks in the parks enclaved in the suburban London streets. I would take it home to meet its grandmother. It might have my large blue eyes and my dark blonde hair.

I would teach them about animals. We would have a dog and the dog would love the baby and stay near it all the time. Religion would not come into it. That is something they can find for themselves when they are older, should they ever want to.

But those are ideals; what if I fell into a depression, who would love my baby then? And what if mania struck and I was violent, aggressive or psychotic, and believed the child to be special, worshipped and gifted? So often, it is without warning and now it’s only my life I am ruining. Those light boxes in a baby’s room that spin with shapes of witches and cats are for the child and yet I know if I wasn’t well I would be afraid of them.

That’s only now, though, I’m 21 and y’know, maybe in the future…