Monday, April 30, 2012

What is Cyclothymia


When I tell people I have cyclothymia, 9.5 times out of 10 they give me a blank stare  - the remaining 0.5 being those in the medical/mental health field or possibly those who have a mood cycling disorder themselves. In fact, as I type, my computer’s spell check keeps putting the squiggly red underline beneath the word, which indicates “this isn’t a word”. It’s that unknown. (Though the fact that it still changes "Pinterest" to “interest” does make me feel slightly better – perhaps my computer just isn’t all that intelligent and adaptable.)

Before I go any further, I feel the need to preface the rest of this blog with this statement: I’m not a mental health professional, I’m not using technical terms other than the very basics, and by no means should anyone read this and try to diagnose themselves with cyclothymia or any other disorder based on my story. This is my description of my condition and what I’ve gone through in my own words, and that is all.  

With that out of the way with, here we go. Cyclothymia is a mood cycling condition that’s “milder” than the better-known Bipolar Disorder. I put milder in quotes because what I go through isn’t always mild. It’s just not as severe as other conditions in the mood cycling continuum. As I mentioned above, Cyclothymia is rare. I’ve found multiple sources that put the prevalence between 0.4% and 1% of the population.*  Because I’m particularly special, I have the rapid cycling form of cyclothymia, which means that my depressed and hypomanic cycles can happen much faster than the those with the “traditional” form of a mood cycling disorder. Technically, a rapid cycling mood disorder is defined by four or more manic, hypomanic or depressive episodes in any 12-month period.  Let me give you an idea of how rapid my cycling is – I can wake up depressed, be hypomanic by noon (particularly if I don’t take my meds on time) and be depressed again by bedtime.  I don’t have specific numbers for the prevalence of rapid cycling, but WebMD lists the prevalence for rapid cycling Bipolar Disorder at 10 to 20% of people with BPD.** If these numbers hold true for Cyclothymia, that means that a maximum of 1/5th (20%) of 1% of the population has rapid cycling cyclothymia. If my math is correct, that’s 0.002% of the population. I guess genetics in the womb foresaw my “I like to be unique” attitude and took it to the extreme.

People often ask me what my mood cycles are like. I describe the hypomanic cycles as such: think about drinking a pot of coffee (or two) all at once, assuming you don’t do this regularly, and then having to sit at your desk, work,  and go about your daily routine. You feel anxious, energetic – though not always in a good way, sometimes irritable, jittery. It’s difficult to focus or concentrate, you feel like your head is swimming, like you could run ten miles (again assuming you don’t normally do this - I don't).  The depressive cycles feel, well, depressive. I tend to lack energy, feel unmotivated and down. Probably the most frustrating feeling of all for me in a depressive cycle is the apathy. I am generally a very passionate person, full of emotion and with a big heart.  To feel like I don't care one way or the other about things is almost frightening for me. It's often the most troubling depressive symptom. 

While I’m discussing the cycles themselves, let me place to rest a huge misunderstanding. Even the most rapid cycling of rapid cycling doesn’t suddenly become manic or depressed mid-sentence (or at least I've never heard of or experienced this).  I hate when I hear people say something like “yeah he was talking to me and was really nice and then all of a sudden he just flipped out. It’s like he’s bipolar.” I’ll tell you something – the “he” in this scenario most likely does not have bipolar disorder or cyclothymia or any other mood disorder. He may be having a really bad day or possibly have some anger management issues or maybe he’s just a jerk, but bipolar, or cyclothymic, he probably is not.  Using the coffee comparison from earlier (I really like coffee), you don’t take a sip and suddenly bounce out of your chair.  You start to feel the effects gradually.  A cup of coffee is probably fine, two might make you a little extra energetic, but by the time you finish the whole pot, you’re probably in a state that you don’t want to be in, or at least one that makes it tough to sit down and concentrate. This is how a hypomanic state comes on. The depressive cycle is similar, though for me personally, I tend to feel most depressive states when I wake up in the morning. I’m not sure if this is common or not.  They’re also a bit tougher to distinguish, because maybe I’m just overly tired and feeling lazy, or maybe I’ve had a bad day/week and I’m down about it like anyone (i.e. someone without depressive issues) would be. I’ve learned slowly to separate these feelings, but it takes a lot of practice and I’m still not 100 percent accurate in my determinations.  

This is a very general overview of the cyclothymia and the way it affects me. No two people feel it exactly the same, and I’m sure others may have completely different experiences. But I realized that while I’ve talked a lot about my condition, my journey, and my desire to increase support, education and awareness for mood disorders, I hadn’t given a good description of what specifically Cyclothymia is. I wrote this as part of a two-part series. Part two goes a bit more in depth into my background of Cyclothymia and how I was diagnosed. As always, I’m happy to answer any questions. If you’d prefer to not leave something in the comments section for personal reasons, you’re always welcome to contact me directly.

Resources for statistics in this blog:
*Sites for Cyclothymia statistics as given in this blog:
MHC

**WebMD source on prevalence of rapid cycling BPD.


37 comments:

  1. Hi, I've been reading through a few blogs on cyclothymia and yours is the first I have came across that seems to have the same cycle of mood changes as mine, mines also change so quickly. I don't know how to contact you directly, but I will try leave my email (nicole8m9@yahoo.com) and you could contact me. Thanks x

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  2. Hello, and thank you for the comment. What type of information are you looking for on rapid cycling? While I'm happy to provide information, I prefer to do it via my blog or facebook page (www.facebook.com/liliesandelephants) on which you can send a private message. Please know I'm not a mental health professional, but I do suffer from a rapid cycling mood condition, as you see in my blog. That being said, I'm happy to provide any information I can from my diagnosis and personal experiences.
    Best,
    Maya

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  3. Oh wow thank you so much for writing this! I have not been diagnosed yet but the more I read about this the closer I get to figuring out what's wrong with me... It's hard to look at a list and compare my experiences to it; reading this, however, I know EXACTLY what you mean! Just wanted to say thanks! :D

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  4. You're welcome! I'm glad that it was able to help. I'm sorry you are dealing with a condition like this, but I can say that once I found out, it was much easier to control and deal with. Good luck!!

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  5. Well I have not been diagnosed, but have struggled with mood swings for some years, not knowing quite what they were. But this is close! So will let you know re diagnosis Jenny

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    1. Hi Jenny,
      Thank you for your comment. i'm glad that my post helped give you some insight. Everyone is a bit different when it comes to symptoms and how the condition reacts with them, so really talking to someone who can take an overall look at your symptoms and family history of any conditions is key. Cycling is quite genetic, so might be good to do some research into family health history. It doesn't have to be a direct line - could be a great uncle or aunt or something with some sort of cycling that is passed down along the way.

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  6. hey , my boyfriend has cyclothymia , we have been dating for 40 days now , and he has been in the depressive phase 3 weeks from now :( i hardly see him once a week and he hardly answers my messages (as he say he needs to be alone while in this phase and doesn't like people asking about him it ads pressure on him) shall i keep trying to communicate even he doesn't answer or leave him to recover? does he feels apathy towards me? :( what can i do?

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    1. I'm sorry to hear that your boyfriend is dealing with this. I am not a licensed psychologist/councelor so I cannot specifically tell you what to do specifically (or I feel it wouldn't be right of me to do so). However, I can say that when in a depressive phase, often it feels like nobody understands you - even if they do - and you just can't feel much emotion towards anything. This doesn't mean I don't care deep down but it's just hard to get in touch with emotions during those times. Do you know a close friend or family member of his that you could talk to about it, just to see how he's doing? That could help you with a bit of insight into what is best for him during these times.

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  7. dear Maya thank you for replying :) no i didn't have the chance to meet a member of his family or closed friends... i have read a LOT of articles about cyclothymia and all of them talk about the lack of emotions and as you just mentioned it u made me feel more relieved :) i love him , i guess i will be patient until he goes "out " of this "down " phase ... much appreciation ! i love reading your blog , it makes things look more positive! take care .

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    1. I am so glad that my blog helps things look more positive for you. Yes, cyclothymia is interesting because it tends to be a very emotional condition - ie extremes one way or the other - but in the down phases, it can almost feel like the emotion has been sucked out of you. I hope things get easier for both you and your boyfriend. One of the few "good" things about cycling is that you know if you're down (or someone you love is) you will eventually be back up again. Patience is key, but so much easier said than done!

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  8. I was recently diagnosed with Cyclothymia after about two years of various forms of therapy and self-help have been limited in helping me with my fluctuating moods, especially my irritability. I had altered my diet, exercise program, adopted anxiety-reducing activities like yoga and journaling, and even underwent continuous psychotherapy. Although I felt better in regards to my personal growth, my moods of course were unchanged. Although I learned how to manage my extreme changes in mood as positively as I could, I felt ‘off’ still and so my dr and I explored other things and there you have it; a diagnosis that makes sense to me, especially after reading your post. I also have rapid-cycling Cyclothymia that varies by day, week, and month. It’s a rollercoaster and exhausting.

    I am still exploring what kind of medication I am comfortable with taking for it however. What was recommended to you?

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    1. Hi Kae,
      Thank you for your comment. I'm glad to hear that you feel that your therapy and self-help have been helping you. I am also a huge fan of journaling, yoga, and meditation for those "in between" times when your moods start to feel worse but you don't have the opportunity to go right to a therapist.

      As for medication, mine has been absolutely fantastic. That said, I am not a medical professional, so I can only tell you abut my personal experience, and what I've learned from my therapist. I currently take a generic form of Trileptol (called Oxcarpazepine). It is actually an anti-seizure medication with a secondary use for mood cycling, which is true of several other medications often prescribed for cyclothymia and bipolar disorder (such as tegretol). It took a while to work up to my current dose, and it truly is a trial and error. I will say, at first I felt almost worse, as it had side effects like dizziness, nausea, and disorientation. But once I got used to the meds, the side effects generally faded away and I am now so happy I've found it. While taking meds several times a day isn't ideal, feeling as I did before them is worse. The medication does have some negative interactions with others, most notably hormonal birth control, so it's definitely important to check contra-indications, as with any medications. I hope this helps! You are always welcome to email me with further questions if you'd like (information in the contact area of this blog).

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  9. Excellent blog and very relatable. Thanks for sharing your story.

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    1. Thank you! I apologize, just saw this notification now!

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  10. Hello Maya,
    The long distance between comment dates on here shows how few people have or think they have cyclothymia. I had a long fight through my teen years with what I called my 'woefully mellow melancholy'. I often times tried to explain it to my parents, but found I could never quite place the reason. I went to therapy for years and my therapist simply said I was depressed and needed a psychiatrist, back in those days my parents didn't let me saying I was just a teen and didn't need drugs. I'm now 20 and don't need their permission. It made it very hard to stay in relationships due to my stages of 'I don't care about anything'. I'd find that in a wave of gloom, situations would come about, like a friends pet dying, I would care deep down but I couldn't even express it because I was in a state of no empathy, id end up avoiding people because I didn't want to pretend to care. then id go through stages where I'd constantly need their company as my stimuli. when I would be back to happy feelings id get excited, overly ambitious and start writing novels. I'd get two chapters down talk about it to everyone plan a drawn out ending and then snap! just like that I lose interest. I've started and half finished 20 novels. I'm a musician and It is my deepest truest love and then ill just not feel it and go days without wanting to play. it affects my band a lot. The biggest problem is my friends and family think "everyone's depressed" its just an excuse to do whatever you want. Or "everyone's getting diagnosed these days its enabling you to get better just rely on drug." my best friend was diagnosed with Bipolar disorder and we got along great and I was convinced I was too until a few days later I was totally fine. our cycles were nothing alike and my depression wasn't as intense as mania, yet it was still not livable so I went and found myself relating with everything to do with cyclothymia and took multiple tests. waiting to see my therapist from high school still. I thought this isn't bad enough to be bipolar but I'm so unhappy and moody. I cannot stay in love and I'm currently with the most amazing man ever and I love him to death but I want to be alone away from him because I cant handle the emotional roller coaster in my brain all the time. My question is this, I know your not a medical professional but I need to know, how do I stay in a stable relationship when my brain is so unstable? any suggestions on relationships? it doesn't seem fair to be so on and off and being with him doing my favorite things but crying for no reason because I'm so let down that it isn't fun.

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    1. I apologize for the delay in reply. I'm very sorry to hear that you're going through this. I went through, and still do go through, much of the same thing - everything from the feeling like I am completely capable and having all of these big plans to just not being able to follow through with anything or stick with them. As for relationships, I think they are one of the hardest pieces of mood cycling. I have been married, divorced, engaged, un-engaged, and in several other longer term relationships, so I understand how it feels to feel like you just cannot stay in a loving situation. I think, however, you are on the right track. You sound like, at least when you were writing this, you understand that your emotions go in cycles, that you have trouble staying in love, and yet you realize you have someone worth staying with and fighting this for. That is a huge step, and I think the key to being able to stay. Look for patterns in your mood cycles - do you feel worse at certain times of day, certain days of the week, with certain foods, with too much or too little sleep, with certain types of weather? These things can all help you to pinpoint which situations make you feel worst. Then, it's easier to say "I feel like I want to be alone, but I know that I often feel worse during this (fill in the blank) and that it's not the relationship. I just have to wait for it to pass." Share these with him, so that he can understand too. I find it helpful to be as open about everything as possible with your partner. Let him know, as nicely as you can (which I know can be tough at times) when you are feeling bad. Let him know it's not him, but that you desire to spend some time alone at the moment. Maybe you even work it out that you have x amount of time per day or week alone, set it as an appointment, just like you would anything else. It's your "you" time and you can spend it however you choose - doing something you like, or feeling emotional and crying with nobody to see because you feel like you need to do so. Having a schedule might help you to feel better about taking time alone without feeling like it's unfair to him. The bottom line is, with our brains and emotions often feeling unstable, we need as much stability in our day to day as we can, and those in our life need to understand and support that. I hope this helps a little. Sorry for such a long reply!

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  11. I myself suffer from Cyclothymia and this is the first blog that actually makes sense. And I really liked the way you dispelled the bipolar myth.

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    1. Thank you very much. I'm glad you found it useful/helpful. I'm sorry to hear that you suffer from cyclothymia. The good news is, you are not alone, even with this rare condition, and there are always others like myself and those who have commented above who understand what it's truly like.

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  12. Hello. Just came across your blog and wow it really makes sense of how I've been feeling for years (and increasingly so in recent years). Some days I have boundless energy and joy whereby I'll multi-task myself to death, having racing thoughts and sing and dance in my kitchen. Whilst others like today, I just wake up tearful, low and feeling I am/life is pointless. It's wierd but in depressive phases I often have sad songs running through my mind that I can't shut off and I'm convinced they make it worse. Have you ever experienced this? I also moon over the fact that my children are growing too fast, that I'm messing them up for being like this and feeling guilty because of it. I've had lots of counselling and am done talking. Just want strategies to keep well and also, contact with someone who understands. It's been a real comfort to find your blog, thank you for sharing your experiences. Will definitely be checking back in. S x

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    1. Hello, and thanks for reading my blog (and for the comment). I am sorry to hear you are going through all of this. I do completely understand about the sad songs. Oddly while they definitely can make it worse some times, I also find sometimes that they help. There are days when I feel so sad, like everything is welling up inside of me and i can't release it. And then if I hear the sad songs enough (actually hear them or they're in my head), I find can cry it out, and it actually helps to ease the sadness eventually. I can also understand how it feels to be done with talking. While my therapist is wonderful, there are plenty of others who I just don't want to talk to anymore. It's nothing against them, but I'm sick of answering the "whys, whats, whens". "Why are you sad?" "what's wrong now?" "When will you be better?". The answer to all three is usually, I don't know. I am not a parent myself, but I have spoken with others who worry about how their condition or symptoms affect their kids. However, in the end what I discover from most of them is that, above all, the kids want to help their parent feel better, and far from messing them up, it's teaching them compassion and kindness and understanding. I hope this helps a little. Always feel free to comment or to reach out via social media or email. All the best, Maya

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  13. Great blog post! I was recently diagnosed with Cyclothymic Disorder last week. Everything that you experience is exactly what I experience too. I'm also very tired and in a depressive state most of the time I wake up. There are some days that I wake up like a jolt of lightening, and shoot straight out of bed. Thanks so much for sharing!

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    1. Thank you for your comment, and for sharing your experience. I'm sorry to hear that you are going through a tough state right now. The ups and downs can be frustrating as they can make life unpredictable. I guess the only "positive" is that we know they will not last forever.

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  14. Hi Maya,
    I was researching cyclothymia and found you. I've been struggling with my moods for pretty well as long as I can remember. In the last couple of years things seem more extreme. I ve been getting q severe down periods where I go days without leaving the house, swamped in my own negativity and anxiety. The periods of ups are generally shorter and don't involve me going wild at parties etc but just feeling amazing and thinking such big plans! Once started these can come back to haunt me as I struggle to finish things when feeling down. Anyway, a lot of what you and others describe about cyclothymia seems to fit me perfectly. But I can't help thinking, maybe I'm down because I'm just disappointed with my life. Im 34 and I've never had a serious relationship. I havent really succeeded at much career wise as ive never had the rigour to see things through. I've always had social anxiety and low self esteem. Either way, I know I need some help. But how do you ever feel you can know which of your struggles are mental illness/chemical and which are just your personality?
    Thanks a lot
    Rupert

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  15. Hi Rupert,
    Thank you for your comment, and your question. I think knowing your overall personality vs condition is a very fine line, and it can be difficult, because it's quite easy for the lines to blur. I try to look for patters. i.e. Do the periods of "up" and "down" seem to have any pattern in terms of frequency, length, etc (though for me with rapid cycling, this can be tricky as there isn't as much of a pattern). Similarly, are they triggered by anything particular. For instance, if you're primarily feeling down when struggling with thoughts about work, relationships, or any other life "situation", for lack of a better word, then it could just be your own thoughts on your life, though that's certainly not always the case. If there seems to be no particular trigger (i.e. I'll just wake up feeling depressed), then I'd say in my experience, it's more likely something medical going on. It's rare for people to just wake up depressed regularly without any external trigger. Perhaps, if you're feeling bad about your life, use those big plans you create in your better moods as motivation - don't be too tough on yourself, but I find that if I have a goal, and I can break it down into manageable parts, even if I can do one tiny thing on my down days to work towards it (sending an email, making a call, reaching out to someone, whatever you feel you're up for at the moment), then it helps me feel like I'm working on something, and less like a failure (I go through a ton of that too!), plus it makes me at least do one thing that day, even if I do nothing else. I hope this helps a little bit. I'm sorry to hear you're going through all of this.

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  16. Hi Maya,
    Thanks a lot for your thoughtful answer. It makes a lot of sense to me. I think for me the down times do come at unpredictable times. Equally they can swing the other way very unpredictably. But when I am down the negative thoughts about my life take over. They can vary in length although typically a very down period can be around a couple of weeks. I m unsure about whether Im making too much of it as partly its just my British mentality - just grin and bear it! Also I finally bit the bullet and spoke to a GP last year who was pretty dismissive. She also advised against seeing the local psychiatrist who she said would probably just prescribe something unnecessarily. Anyway I just want to get more opinions from people I have confidence in so will seek that out. Thanks again for your reply, much appreciated :)

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    1. Hi Rupert,
      My GP was honestly pretty dismissive too (I no longer see this GP) and gave me something that actually made me worse, b/c with my rapid cycling I can't be on it. It doesn't sound like you're making too much of it, and honestly, it can't hurt to talk to someone just to see. I'm not sure what rules are like there in regards to medicine, but here, only a psychiatrist or other type of doctor can prescribe medication. So many people go first to a counselor/therapist to just talk and not worry about having meds pushed on them, and then, if the therapist thinks a medication would help, they can make a doctor/psychiatrist appointment. Not sure if that's the same over there though? Finding the right therapist/doctor takes a lot of trial and error at times, but it's very much worth it to have someone you can trust.

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  17. Yes thats really what I want is to talk to someone with a lot of experience who can give some good advice. I felt with this GP that she was assuming I was just there seeking medication! Anyway thanks again, I ll let you know how I get on :)

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  18. Hi Maya & others reading this,

    Great post & messages. I am 43 & was diagnosed with Cyclothymia, PTSD & Depression 10 months ago but I think I've had Cyclothymia for most of my life. No one around me understands, but how could they when the illness is so unpredictable we struggle to understand it ourselves?! I do however have a great GP thank goodness. And it's good to be able to read that I'm really not alone in feeling the way I feel. Love & hugs to you all.

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    1. Thank you for sharing your story. I'm sorry that you are battling all of these. Having a good GP, or any doctor/medical professional in your corner is such a great help. Love and hugs to you as well.

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  19. Hi Maya
    I stumbled across your blog when searching for something, but I'm not sure what. Thank you for sharing your story, It's good to see how others cope. Here is my story: After trying to be normal for so long it got too much 6 years ago (age 52). I went to the doctor and told him I was type 2. Some weeks later the diagnosis of Cyclothymia was handed down. Mine is the rapid type like yours, however there can be multiple swings in a day and the depression usually includes suicidal thoughts (this had done on for decades, I thought it was normal). Fortunately medication has alleviated these. At the end of 2014 I was forced to leave my job (primary/elementary teacher) due to problems with anxiety. This continues to be a problem and has also adversely affected subsequent employment to the point where I'm almost unemployable. It's one day at a time. Thank you once again.

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    1. Thank you for your comment, and for sharing your story. I'm sorry to hear that you have been going through all of this. While I'm glad to hear the medication helped the suicidal thoughts (I have battled those as well), I'm sorry to hear that cyclothymia has had such a difficult effect on your career. I too can cycle numerous times in a day, and know how difficult it can be for me to maintain a sense of "normalcy" (as in going through the work day without it affecting work, etc). I hope that things start to improve for you, and I think that your strategy of taking it one day at a time is sometimes the best thing we can do in times like this. Thank you again for sharing your story.

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  20. I am also a very rapid cycler. I cycle multiple times a day. Yesterday I woke up fine, but before lunch I had tears streaming down my face and I had no idea why. Then when I got home from work I was fine and got a lot done. This scares the crap out of everyone who knows me. And the depressive cycles make me withdraw from everyone because I have experienced in the past that nobody wants someone to bring them down. So all I do is isolate myself when I'm depressed. At work, I also have learned to put on a mask. I'm better at it now than I used to, but during depressive episodes I try to stay at my desk with my headphones on so I don't have to interact with someone unless necessary.

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    1. I'm so sorry you're dealing with all this. I too am very rapid and have experienced similar situations, where I'm crying at one point in the day, and a few hours later feeling fine. It's so scary, and those around me don't know what to do. Unfortunately, I think some have chosen to kind of ignore those parts where I'm crying, thinking "this will pass and she'll be fine soon"... which really hurts. I too isolate and hide out in depression. I tend to not want to be around anyone then. I put on a mask all day and so when I take it off, I never want to have to pretend, even around those I'm close to. I also find I take this out on those I can be myself with, unfortunately - I tend to unleash everything I've been holding on to all day, because it feels so good to finally let it go, even if it's misdirected. I always feel awful afterwards.

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  21. Iv recently been to see a therapist for cbt both my therapist and the mental health assessor had never heard of cycloththemia. Has this happened to anyone else? I feel so alone

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    1. Wow! I've not had that from anyone involved in mental health. I have had other medical professionals who haven't heard of it, but not in mental health. I'm so sorry you're feeling alone. Is this a therapist you've been with or someone new? If new, maybe not the one for you? Your therapist should never contribute to your feeling alone. I'm so sorry.

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  22. No she's not new . I really don't want to give up on it but it's so scary trying to get your head around the actual mental health issues without having to explain it to someone there to help. I'm trying a lot of meditation and yoga sessions that seems to help . Also 100mg of setraline a day which has just been increased as I'm getting a little unsteady. Have you found medication or other outlets helpful. Has anyone else felt so isolated?

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    1. I try to do yoga and meditation as many days a week as I can, which does help. Writing (journaling and just writing in general) also helps me greatly. I find my medication incredibly helpful, though I certainly cycle plenty still - just not as much as I probably would otherwise. I feel incredibly isolated - it's so tough to explain to those who don't go through it, even if they technically understand it. It can be very lonely.

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