A Sudden Shift in Moods

"It's kind of a cookbook diagnosis that's based on a standard number of criteria the patient meets," explains Dave M. Davis, a clinical psychiatrist and medical director of the Piedmont Psychiatric Clinic in Atlanta.

Currently, mental health professionals rely on a clinical evaluation, DSM-IV checklists and an accurate history of the person's moods and behavior. A relative of the patient can often help with compiling such a history, Goodwin said, because he can make connections between a person's behavior and negative consequences or recall a pattern of behavior.

"I had a lawyer once who had come in because he was feeling depressed," Goodwin recalls. "He didn't see himself as hypomanic, but he was so irritable that his kids didn't want to come home and eat with him. His wife reminded him it was the same summer that he bought three cars and called all of his bosses [expletive]s and got fired. Then he turned to his wife and said, 'Is this what the doctor meant by hypomania?' He just hadn't put two and two together."

Back on an Even Keel

"There isn't much point in treating cyclothymia without mood stabilizers," Goodwin said. "This is not something over which [people] can exert total voluntary control."

While drugs like lithium and depakote have been the treatment of choice for both bipolar and cyclothymic disorders in the past, they often carry unpleasant side effects such as weight gain and sluggishness.

In 2003, a breakthrough came with the FDA's approval of Lamictal for the long-term treatment of bipolar disorders. "It's very effective on the depressive side and mildly effective on the high side," Goodwin said. "With it, these people can begin to trust their emotions again."

What doesn't help are antidepressants taken by themselves, as Jennifer Richards discovered after being misdiagnosed with depression more than 10 years ago.

"The antidepressants I was given made my moods worse," recalled Richards, a receptionist in Boston. "I'd feel invincible and drive 100 miles an hour or max out my credit cards. Or I'd become very angry, loud and obnoxious; I hadn't experienced outbursts like that before. Friends stopped talking to me, and I was fired from two jobs."

It wasn't until she began treatment with a new psychotherapist that she was diagnosed with cyclothymia and put on a mood stabilizer. After that, she said, "I wasn't afraid of myself anymore."

Not only can antidepressants throw someone with cyclothymia into mania, they can boost the risk of having the disorder evolve into full-blown bipolar, Goodwin said. "It happens up to one-third of the time. Antidepressants should only be used with a mood stabilizer, and they should not be used indefinitely."

The trouble is, people are often reluctant to take a mood stabilizer when they're on a high swing.

"When you're hypomanic and you feel euphoric and on top of the world, who wants to take a medication that will take that away?" said Prentiss Price, a psychologist at the Counseling and Career Development Center of the Georgia Southern University in Statesboro and author of "The Cyclothymia Workbook." "But the higher the mood gets, the more at risk you are for problems with judgment or risky behavior."

Of course, therapy is also important. "They need to relearn who they are and get off their addiction to their highs," Goodwin said. "It's like cocaine addicts: They feel like they need that high to be interesting, appealing, sexually attractive or fun people."

Thanks to medication and psychotherapy, Andrew Solomon's moods are now under control: He still has up days and down days, but he spends more time on an even keel.

"Now I usually have reactive swings," he said. "When something happens, I might have an exaggerated response to it. But my moods have become more logical and rational and less extreme. They're easier for me and for other people to live with."

Resources

For more information about mood disorders:

Families for Depression Awareness ( http://www.familyaware.org/ ), offers help in recognizing and dealing with depressive and mood disorders.

Depression and Bipolar Support Alliance ( http://www.dbsalliance.org/ ), offers confidential screening for bipolar disorder, depression and anxiety, plus information and referrals to support groups.

Stacey Colino is a Washington area freelance writer. Comments: health@washpost.com.