Cyclothymia Case Study: 28-Year-Old Interior Designer from Pune With Years of Mood Swings That Were Put Down to Stress and a Creative Temperament
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Cyclothymia Case Study: Patient Background
This cyclothymia case study follows Aditya (name changed), a composite example that reflects how long-term, milder mood swings are often missed and how they are assessed and treated at Calida Rehab. The details are illustrative and do not describe any one identifiable person.
Aditya is a 28-year-old interior designer who runs a small studio in Pune. He lives with his parents and has a younger sister. Friends describe him as talented, restless and “intense”. For about five years his mood and energy had moved up and down in short cycles. For two or three days he would feel unusually energetic and sure of himself, sleep four or five hours without feeling tired, talk quickly and take on more projects than any one person could manage. Then, over the next week or two, his energy would drain away. He felt flat, irritable and critical of himself, and he found it hard to reply to clients.
Because neither the highs nor the lows were severe enough to stop him working or to need hospital care, each one was blamed on something else: a deadline, a breakup, a hard client, or “the creative temperament”. A general physician diagnosed stress. A counsellor helped with the low periods. A doctor once prescribed an antidepressant for the low phase. Within a few weeks he felt restless, wired and irritable, and he barely slept, so he stopped it on his own. What finally brought him to us was a bad month. After a high week in which he agreed to five new projects and spent heavily on equipment, he crashed, missed a deadline and lost a major client. His mother, who had quietly noticed that he seemed like “a different person every few weeks”, persuaded him to come.
Before the case itself, a short note. Cyclothymia, also called cyclothymic disorder, is a long-term mood condition marked by many short periods of mild high mood and many periods of mild low mood. The swings are milder than in bipolar disorder, but they last for years, and they affect work, money and relationships. To see how it relates to other mood conditions, read our guide on bipolar disorder. You may also want to read our bipolar II disorder case study and our bipolar disorder case study.
Symptoms: How the Highs and Lows Showed Up
Cyclothymia rarely looks like an illness. It looks like a person with a changeable mood who is sometimes brilliant and sometimes unreliable. In Aditya’s case, two patterns kept repeating.
The short highs (two to three days at a time):
- More energy than usual and a feeling of being unusually sure and creative
- Sleeping four to five hours and still feeling rested
- Talking faster and more than usual, and jumping from one idea to another
- Taking on many projects at once and working late into the night
- Spending more than planned, especially on equipment and software
- Becoming short-tempered when others could not keep up
The lows (one to two weeks at a time):
- Low energy and a heavy, flat feeling in the mornings
- Sleeping longer and finding it hard to get out of bed
- Self-doubt and the belief that his work was not good enough
- Avoiding calls and messages from clients and friends
- Poor concentration and slow decisions
- Irritability and a short temper at home
In the last year, he had begun to have a few drinks on weekends to “come down” after a busy, high-energy stretch. He had no thoughts of harming himself, and he had never been so unwell that he could not work.
Why Cyclothymia Is Often Mistaken for Temperament or Stress
Cyclothymia is often missed for years. Several reasons make it easy to overlook, and they are worth knowing.
- The highs feel good. A person rarely complains of feeling energetic and creative, so the highs are praised and only the lows are reported.
- The swings are short and mild. They never reach the level of a full manic, hypomanic or major depressive episode, so each one is easy to explain away.
- It looks like personality. Because it begins early and lasts for years, the person and the family start to treat it as temperament.
- It can be made worse by the wrong treatment. An antidepressant given alone for a low phase can trigger restlessness, irritability or a high in some people with mood swings. This is why the full history matters before medicine is started.
- It can progress. In some people, cyclothymia later develops into bipolar I or bipolar II disorder, so regular follow-up matters even when things are going well.
For Aditya, the hardest part was accepting that the pattern was a medical condition and not a flaw of character or a price of being creative.
Diagnosis: How Cyclothymia Was Assessed at Calida Rehab
There is no blood test for cyclothymia. A psychiatrist makes the diagnosis from a detailed history, a mental state examination and a record of mood over time. For Aditya, the assessment included:
- A life-chart of mood: a timeline of the ups and downs over the past five years, including the antidepressant trial, built with his own memory and, with his consent, his mother’s account.
- Symptom review against DSM-5-TR and ICD-11: in adults, at least two years of many periods with hypomanic-type symptoms and many periods with depressive symptoms, present at least half the time, with no symptom-free stretch longer than two months, and no history of a full manic, hypomanic or major depressive episode.
- A check for full episodes: his highs lasted two to three days and included only some symptoms. They never reached the four-day, clearly changed pattern of a hypomanic episode. His lows were never severe enough to meet the criteria for a major depressive episode. If they had been, the diagnosis would have been bipolar II disorder.
- Mood Disorder Questionnaire (MDQ) and PHQ-9: the MDQ was positive, and his PHQ-9 on the day of assessment was 11, in the moderate range.
- Family history: a maternal uncle had been treated for bipolar disorder, which raised the importance of careful follow-up.
- Screening for other causes: alcohol, cannabis, stimulants and energy drinks; ADHD; and personality difficulties, because their symptoms can look similar.
- Physical checks: blood tests for thyroid function, blood count and blood sugar, because thyroid problems and other medical conditions can cause mood swings.
- Suicide risk review: a direct conversation about his thoughts. He had none.
The diagnosis was cyclothymic disorder. His thyroid and blood tests were normal. His weekend drinking was noted as a factor that could make the swings worse. To read about the related conditions, see our guide to bipolar disorder treatment.
Treatment Plan for Cyclothymia
No single treatment suits everyone. At Calida Rehab the plan is built after the assessment and reviewed often. Because Aditya had no safety concerns and was still working, his plan was based on outpatient visits, with a short stay offered if he needed one. It had these parts.
- Explaining the diagnosis: a clear, unhurried conversation about what cyclothymia is, why it had been missed, and why the antidepressant had made him restless.
- A daily mood chart: a short note each evening on mood, energy, hours of sleep and spending, so that patterns could be seen and not guessed.
- Regular sleep and daily routine: fixed sleep and wake times, regular meals and set working hours, because irregular sleep is a strong trigger for mood swings.
- Cutting triggers: no alcohol, a limit on caffeine and energy drinks, and no cannabis or stimulants.
- Medicine, decided together: not everyone with cyclothymia needs medicine. Because his swings were affecting work and money, the psychiatrist discussed a mood-stabilising medicine such as lithium, explained the blood tests and monitoring it needs, and agreed on a trial. He was told that he should avoid taking an antidepressant on its own.
- Structured psychotherapy: sessions of cognitive behavioural therapy and psychoeducation, along with work on daily and social rhythms.
- A money safeguard: a rule that any large purchase is delayed for 48 hours and discussed with a trusted person.
- Family session: his mother and sister attended, so that they understood the pattern and knew how to raise a concern without arguing.
The team also explained that cyclothymia is a long-term condition, and that the aim of treatment is steadier mood and a plan for early warning signs, not a mood that never changes.
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Therapies Used in This Cyclothymia Case Study
The therapies below were part of Aditya’s plan and are commonly used for cyclothymia and related mood conditions.
- Psychoeducation: clear teaching about mood cycles, triggers, sleep, medicine and early warning signs for him and his family. See our psychoeducation page.
- Cognitive Behavioral Therapy (CBT): worked on thoughts such as “I am only worth anything when I am on a high” and on the self-criticism during the low weeks. See our CBT page.
- Interpersonal Therapy (IPT): focused on keeping a steady daily and social routine, and on the strain that the swings had put on his family and clients. See our interpersonal therapy page.
- Behavioral therapy: planned his week so that high-energy days did not lead to over-commitment, and low days still held a small, doable task. See our behavioral therapy page.
- Family therapy: helped his family recognise early signs and respond calmly, without blaming. See our family therapy page.
- Meditation therapy: a short daily practice that helped him notice the first signs of a rising or falling mood. See our meditation therapy page.
Follow-Up Care After the Diagnosis
Because cyclothymia is a long-term condition, the plan does not end after the first few visits. Aditya’s aftercare was written down early:
- Weekly therapy for the first two months, then every two weeks.
- Psychiatrist reviews every month for the first three months, then every two to three months, to check mood, sleep, side effects and any blood tests that his medicine needs.
- The mood chart reviewed at every visit, so changes could be seen early.
- A short written list of his early warning signs: sleeping under five hours for two nights, agreeing to more than two new projects at once, strong urges to spend, or unusual irritability.
- A plan to follow the same steps each time: call the team, keep to the sleep routine, delay big decisions, and bring the chart.
- Continued medicine as advised, with any change made together with the psychiatrist and never stopped suddenly.
- Regular review for any sign that the pattern is changing into bipolar disorder.
His mother also had a contact number and was told that it was fine to call if she noticed a change.
Outcome: What Recovery Looks Like in Cyclothymia
What changed for Aditya over the first six months:
- Mood swings: the number of days he marked as clearly high or low fell from about fourteen a month to about five by month three. By month six, he had only brief, mild shifts.
- Sleep: he kept to about seven hours most nights, and for the first time he could see how a short night was often the start of a high.
- Medicine: he took it daily, attended every blood test and review, and had mild side effects in the first two weeks that settled.
- Work: he agreed to a limit on the number of projects at a time, met his deadlines and kept his remaining clients.
- Money: he followed the 48-hour rule and stopped unplanned purchases.
- Alcohol: he stopped his weekend drinking and said he no longer needed it to “come down”.
- Family: his mother said that she could now talk about his mood without it turning into a quarrel.
It is worth being clear about what recovery means. It does not mean that mood never changes. Everyone has good and bad days. It means that the swings are smaller, that early signs are recognised and acted on, and that the person understands the pattern. Because cyclothymia can change over time, regular follow-up continues even when things go well.
What the first six months of treatment usually look like
- Weeks 1 and 2: assessment, physical checks, explanation of the diagnosis and a mood chart started.
- Months 1 and 2: weekly therapy, sleep and routine built up, and a medicine trial if it is advised.
- Months 3 and 4: fortnightly therapy, medicine reviewed, early warning plan practised.
- Months 5 and 6: reviews every one to two months if steady, medicine continued and a plan for the next year.
This is a general guide. Every person moves at a different pace, and the length and type of follow-up is decided by the treating team.
Key Takeaways from This Cyclothymia Case Study
- Cyclothymia is a long-term mood condition with many short periods of mild highs and mild lows, lasting at least two years in adults. It is a medical condition and not a personality trait.
- It is often missed because the highs feel good and the swings are milder than in bipolar disorder.
- Diagnosis needs a careful history, a mood chart, screening for other causes and a check that the person has never had a full manic, hypomanic or major depressive episode.
- An antidepressant taken alone can make mood swings worse in some people, so the full history matters before any medicine is started.
- Regular sleep, fewer triggers such as alcohol and caffeine, psychoeducation, therapy and, for some people, a mood-stabilising medicine all help.
- It can progress to bipolar disorder in some people, so follow-up is important even when things are going well.
When Should You See a Doctor?
Please speak to a doctor or psychiatrist if you or someone you know:
- Has had repeated ups and downs in mood and energy for two years or more
- Has short spells of unusual energy, little need for sleep or racing thoughts, followed by flat or low periods
- Has been told that it is just stress, temperament or a creative personality, but the swings keep affecting work, money or relationships
- Became restless, irritable or unable to sleep after starting an antidepressant
- Is using alcohol, cannabis or other substances to come down from a high or lift a low
- Has a family history of bipolar disorder and is noticing mood swings
Please do not stop or change any medicine on your own. If a high lasts four days or more, or leads to risky behaviour, or if someone talks about ending their life, has made a plan or cannot stay safe, do not wait. Call 112 or Tele-MANAS on 14416 and stay with the person until help arrives. You can also call our 24-hour helpline for a confidential conversation. For more on assessment, read our guide on when to take a depression test.
Cyclothymia Case Study: Frequently Asked Questions
What is cyclothymia?
Cyclothymia, or cyclothymic disorder, is a long-term mood condition in which a person has many short periods of mild high mood and many periods of mild low mood. In adults it must last for at least two years. The swings are milder than in bipolar I or bipolar II disorder, but they can still affect work, money and relationships.
How is cyclothymia different from bipolar disorder?
In bipolar I and II disorder, a person has had a full manic or hypomanic episode, and often a major depressive episode. In cyclothymia, the highs and lows never reach that level. They are milder, shorter or involve fewer symptoms. A psychiatrist decides between them from a careful history and a mood record.
How long must symptoms last for a diagnosis?
In adults, at least two years. In children and teenagers, at least one year. During this time the person should have had symptoms at least half of the time, and should not have been free of them for more than two months at a stretch.
Is cyclothymia just mood swings or part of my personality?
No. Everyone has changes in mood, but in cyclothymia the swings are repeated, last for years and affect daily life. Because it begins early, it can feel like part of who you are, but it is a recognised and treatable condition.
Can cyclothymia turn into bipolar disorder?
In some people, yes. Studies show that a notable share of people with cyclothymia later develop bipolar I or bipolar II disorder. This is why regular follow-up, a mood chart and attention to sleep and triggers are part of care, even when things seem stable.
How is cyclothymia diagnosed?
There is no single test. A psychiatrist reviews the history of highs and lows, family history and any use of alcohol or other substances, and often uses a mood chart and screening tools such as the Mood Disorder Questionnaire. Blood tests help to rule out thyroid and other medical causes.
How is cyclothymia treated?
Treatment usually combines psychoeducation, therapy such as CBT and interpersonal therapy, a steady sleep and daily routine, and avoiding triggers such as alcohol and heavy caffeine. Some people also benefit from a mood-stabilising medicine. The plan is decided with your psychiatrist.
Are antidepressants safe in cyclothymia?
An antidepressant taken alone can cause restlessness, irritability or a high in some people with mood swings, and it may not help the pattern. Antidepressants should only be used when a psychiatrist has reviewed the full history. Do not stop or start them on your own.
What can family members do?
They can learn the early warning signs, help to keep sleep and routine steady, raise concerns calmly and encourage the person to speak to the treating team. Avoid shouting, blaming or calling the person moody. Taking part in family sessions and looking after your own wellbeing helps too.
Is my information kept private?
Yes. Assessment and treatment details are confidential and are shared with family or employers only with your consent.
Sources and Further Reading
This page is for information and is not a substitute for medical advice. The case described is a composite example, and details are illustrative. If you think you or someone you know may have a mood disorder, please see a doctor or psychiatrist for a full assessment. If anyone is at risk of self-harm, call 112 or Tele-MANAS on 14416 at once.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.
- World Health Organization. International Classification of Diseases, 11th Revision (ICD-11), 6A62 Cyclothymic disorder.
- Van Meter AR, Youngstrom EA, Findling RL. Cyclothymic disorder: a critical review. Clinical Psychology Review, 2012; 32(4): 229-243.
- Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry, 2000; 157(11): 1873-1875.
- Frank E, Kupfer DJ, Thase ME, et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of General Psychiatry, 2005; 62(9): 996-1004.
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 2001; 16(9): 606-613.
- National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185). 2014, updated 2023.