Cyclothymic Disorder. While cyclothymic disorder is not as severe as either bipolar disorder II or I, the condition is more chronic. Hypomanic symptoms tend toward irritability as compared to the more euphoric symptoms of bipolar II. (One report, in fact, referred to these patients as having "darker" natures while bipolar II patients were "sunnier.")
The disorder lasts at least 2 years, with single episodes persisting for more than 2 months. Cyclothymic disorder may be a precursor to full-blown bipolar disorder in some people or it may continue as a low-grade chronic condition.
Course of the Illness
Bipolar disorder can be severe and long-term, or it can be mild with infrequent episodes. Patients with the disease may experience symptoms in very different ways. A typical bipolar disorder patient averages 8 - 10 manic or depressive episodes over a lifetime. However, some people experience more and some fewer episodes.
Typical Bipolar Cycles. In most cases of bipolar disorder, the depressive phases far outnumber manic phases, and the cycles of mania and depression are neither regular nor predictable. Many patients, in fact, experience mixed mania, or a mixed state, in which both mania and depression coexist.
Rapid Cycling. About 15% of patients with the disorder have a temporary, complicated phase known as rapid cycling. With this phase the manic and depressive episodes alternate at least four times a year and, in severe cases, can even progress to several cycles a day. Rapid cycling tends to occur more often in women and in those with bipolar II. Typically, rapid cycling starts in the depressive phase, and frequent and severe episodes of depression may be the hallmark of this event. This phase is difficult to treat, particularly since antidepressants can trigger the switch to mania and set up a cyclical pattern.
Differences Between Children and Adults. An important 2006 study indicated that children and adolescents with bipolar disorder experience a very different disease course than adults. The symptoms of children tend to last longer than adults, and their mood swings change more rapidly. Young patients may also be more likely than adults to convert from one bipolar subtype to another, for example from unspecified bipolar to bipolar I or II. The study also suggested that patients whose bipolar disorder emerged in their pre-teen years tend to display more symptoms than those whose illness began in their teens.
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