The term “depression” often refers to major depressive disorder. But it can also serve as an umbrella term that encompasses several types of depression.
Depression doesn’t follow the same pattern for everyone. It can involve quite a bit of variety in not just your symptoms, but how severe they are and how long they last.
Major depression, for example, involves mild to severe episodes of depression that last at least 2 weeks. Dysthymia, or persistent depressive disorder, typically involves milder symptoms that linger for years rather than weeks or months.
Plenty of people living with depression never link their symptoms to a specific subtype of depression. It might not seem to matter all that much what type of depression you have, as long as you get support — after all, treatment is treatment, right?
But some types of depression do respond better to certain treatments. Even finding the most helpful therapy approach can depend, at least in part, on the type of depression you have. That’s why tracking any patterns your symptoms tend to take can provide some important insight that leads to more effective treatment.
If you’ve noticed your depression symptoms tend to happen in cycles, you’ve come to the right place.
Cyclical depression isn’t an official mental health diagnosis, and mental health professionals likely won’t use this term. That said, certain types of depression do follow a pattern. These symptoms come and go in some type of cycle instead of persisting day in and day out.
Below, we’ll explore a few types of depression that involve cyclical symptoms, plus offer some guidance on getting support.
The “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)” lists this condition under “Bipolar and Related Disorders.” In other words, experts technically don’t consider it a type of depression.
That said, if you live with this condition, your symptoms might resemble cycles of depression.
Cyclothymia involves fluctuating periods of hypomania, or an elevated mood, and depression, or a low mood.
During periods of depression, you might:
- feel low, sad, irritable, or hopeless
- have less energy than you typically would
- avoid spending time with loved ones
- lose interest in your regular routine
- find it difficult to enjoy everyday life
During a period of hypomania, you might:
- feel more energized and confident than usual
- have more interest in socializing
- talk more than you generally would
- feel highly motivated to get things done
- take risks you typically wouldn’t
Hypomania isn’t as severe as mania, the extremely elated and grandiose mood state that characterizes bipolar I disorder. With cyclothymia, hypomania that follows depression could seem like your mood has taken a turn for the better.
Not everyone who experiences hypomania finds it distressing. Since you may not even realize these mood changes represent mental health symptoms, the periods of depression might stand out more sharply — especially if you enjoy the periods of excitement and high energy.
What’s the difference between cyclothymia and bipolar disorder?
A few key differences set these two conditions apart:
- With cyclothymia, you never experience enough symptoms to meet the diagnostic criteria for bipolar disorder. Instead, you might experience just one or two symptoms of hypomania at a time, or three symptoms of depression.
- Symptoms of cyclothymia tend to be milder than symptoms of bipolar disorder.
- With bipolar disorder, any length of time can pass between mood episodes. But cyclothymia symptoms remain present at least half the time, for at least 2 years. Symptom-free periods won’t last any longer than 2 months.
Since cyclothymia can raise your chances of eventually developing bipolar disorder, getting support as soon as you notice symptoms is a good option.
What does treatment involve?
Treatment for cyclothymia generally involves a combination of:
- Therapy. Cognitive behavioral therapy (CBT) and other therapy approaches can help you learn to cope with symptoms and address distressing thoughts and unwanted behaviors.
- Medication. A psychiatrist might prescribe mood stabilizers and antipsychotic medications to help ease symptoms.
- Psychoeducation. Learning more about your condition, including how to recognize early signs of mood shifts, can lead to more successful treatment.
- Coping strategies. A personalized toolbox of tips to cope with episodes of hypomania and depression, from yoga and exercise to art and music, can help you navigate sudden shifts in your mood more effectively.
This subtype of major depression involves symptoms that come and go as the seasons change. Typically, you’ll notice symptoms in the fall and winter, though you could also experience seasonal depression in the spring and summer.
Experts don’t know exactly what causes seasonal depression. But the condition does appear to relate, at least in part, to hormonal changes brought on by reduced exposure to natural light.
That’s why your symptoms might seem to follow a distinct cycle: They appear during the shorter, darker days of fall and winter and improve as spring begins (or vice versa, for spring and summer depression).
The most common signs include:
- changes in your typical energy levels, from low energy and fatigue (winter pattern) to increased restlessness and agitation (summer pattern)
- changes in appetite and weight
- sleep problems, including insomnia or difficulty staying asleep
- difficulty concentrating
- withdrawal from social activities
- feelings of hopelessness, sadness, or worthlessness
To diagnose seasonal depression, a mental health professional will ask questions about the time of year you experience these symptoms and whether you have any symptoms at other times. They’ll also want to know how many cycles you’ve noticed since this diagnosis requires that you experience symptoms at least 2 years in a row.
What does treatment involve?
Specific treatments for seasonal depression might include:
- Therapy. CBT, interpersonal therapy, and other types of therapy can help ease symptoms during the months you experience them.
- Medication. If you experience symptoms each year as fall approaches, a psychiatrist may recommend starting antidepressants shortly before your symptoms tend to begin.
- Light therapy. Exposure to natural light, via the sun or a light therapy box, can help improve depression symptoms by helping balance your levels of serotonin and melatonin.
- Complementary and alternative approaches. Vitamin D supplements, meditation, exercise, and other natural remedies can all have benefit.
This condition, which you’ll find listed in the DSM-5 with other depression conditions, involves a combination of mental, emotional, and physical symptoms. These symptoms begin roughly a week before your menstrual period and end after your period starts.
Along with a low, sad mood and a sense of hopelessness, PMDD might cause:
- anxiety, restlessness, and a sense of doom or panic
- abrupt mood changes
- irritability and anger
- suspicion or paranoia
- low energy and fatigue
- trouble concentrating
- a sense of overwhelm or losing control
- disinterest in your regular daily routine
- changes in your appetite
- difficulty sleeping
- physical PMS symptoms, including head and body tension, bloating, and breast swelling and tenderness
You might not experience these symptoms every single month, but you’ll notice them more months than not. To receive a diagnosis of PMDD, you’ll also need to experience symptoms at least 2 months in a row.
Depression symptoms could also seem cyclical if they regularly get worse around your menstrual cycle, which can happen due to premenstrual exacerbation (PME).
With PME, symptoms of an underlying mood condition like depression or bipolar disorder typically get worse in the week before your period begins. This pattern of more severe symptoms might be even more noticeable if your symptoms remain fairly mild throughout the rest of each month.
What does treatment involve?
- Therapy. Different therapy approaches, including interpersonal therapy, CBT, and acceptance and commitment therapy could all have benefit for PMDD symptoms.
- Medication. A psychiatrist or other prescribing clinician can provide more information about medications that help treat PMDD symptoms. Potential options include antidepressants, Yaz and other hormonal birth control pills that prevent ovulation, and medications that block the production of progesterone and estrogen.
- Self-care. Exercising regularly, getting enough quality sleep, and eating a balanced diet that contains complex carbohydrates and lean proteins can make a difference in your symptoms.
- Stress management techniques. Since stress can worsen PMDD, taking steps to reduce stress in your life may improve symptoms. You might, for example, try relaxation exercises like meditation, yoga, or guided imagery. But it’s also worth reaching out to loved ones for emotional support.
If you experience symptoms of depression that keep returning, connecting with a therapist is always a good next step.
You’ll want to reach out as soon as possible if your symptoms:
- affect your ability to take care of basic needs
- make it difficult to manage daily tasks and responsibilities
- keep you from succeeding at school or work
- create problems in your personal and professional relationships
Even though your symptoms may not seem all that severe — especially when you know they eventually improve —it’s important to recognize that they could get worse over time.
Experts haven’t found a cure for depression. All the same, taking the first steps toward getting a diagnosis and finding an effective treatment could lower your chances of experiencing more serious symptoms in the future.
Keep in mind, too, that a therapist will typically need to track the pattern of your symptoms for a few months to a few years in order to arrive at the correct diagnosis. It never hurts to start this process sooner rather than later.
A therapist can:
- help you explore possible causes of symptoms
- offer guidance on helpful strategies to navigate triggers
- teach techniques to manage and cope with symptoms
- suggest alternative remedies that fit your unique needs and personal lifestyle
- refer you to a psychiatrist, if you’d like to try medication
Not quite ready to start therapy? You can begin tracking your symptoms yourself by keeping a daily journal of mood changes and any other emotional or physical concerns you notice.
Cyclical depression may not be an actual mental health condition, but symptoms of certain types of depression can certainly come and go in cycles.
Only a trained professional can link your symptoms to a specific mental health condition, whether that’s depression, bipolar disorder, or anything else. A therapist can also — and perhaps more importantly — help you find an effective approach to treatment that fits your symptoms and your needs.
Crystal Raypole writes for Healinggeeks and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.
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