What Is Cyclical Depression? Mental Health Symptoms And Treatments

Cyclical depression is a term to describe depressive symptoms that recur periodically throughout someone’s life. It is also sometimes referred to as recurrent depression or bipolar III disorder, since a form of cyclical depression called cyclothymia can be considered a milder form of bipolar disorder. However, being “milder” doesn’t necessarily mean that it cannot contribute to significant distress. Rather than being a DSM-5 diagnosis or clinical mental health disorder, cyclical depression is considered an umbrella term encompassing a range of mood and depressive disorders. 

Any depressive disorder can be a severe impediment in a person’s life, and if you are an individual living with a depressed mood, you may understand how challenging it can be. However, cyclical depression is treatable, and the mental health symptoms associated with this condition may be beneficial to learn about if you’re experiencing it.

What is cyclical depression? 

The symptoms of cyclical depression can vary due to the range of mood and depressive disorders that may have cyclical patterns. If you live with cyclical depression, you might experience periods of profound sadness followed by days with a more elevated mood and energy levels. These mood swings tend to be less severe than those seen in bipolar disorder, which can involve manic or hypomanic symptoms. 

An individual who has cyclical depression might have difficulty performing daily tasks during periods of depressive symptoms. They might also experience cognitive difficulties and social withdrawal. Some research indicates a connection between cyclical depression and other mental health conditions. For instance, those diagnosed with a depressive disorder may also have anxiety-related disorders or post-traumatic stress disorder (PTSD). 

Cyclical depression, physical illness, and PTSD

Many individuals who have been diagnosed with PTSD also have recurrent depression. Emotional reactions and symptoms of anxiety and depression may also accompany any diagnosis of a severe physical illness (like cancer). People diagnosed with cancer often experience symptoms related to anxiety and depression, regardless of whether their treatment leads to remission or is palliative.

Types of cyclical depressive disorders and related mental health conditions

According to the World Health Organization, around 332 million people live with a depressive disorder. While it can be expected for many people to experience depression symptoms after a loss or traumatic change, many people experience these symptoms in a cycle. For some, the symptoms of depression subside temporarily, only to return in episodic periods. This pattern is known as recurrent, cyclic, or cyclical depression.

Rather than being a diagnosis, cyclic depression is a broad term used to describe a range of mood and depressive disorders. These include:

• Cyclothymia
• Persistent depressive disorder (PDD) 
• Seasonal affective disorder (SAD)

Cyclothymia

Cyclothymia, or cyclothymic disorder, is a primary mood disorder. It is categorized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) under the bipolar disorder category.

Symptoms of cyclothymia

Cyclothymic disorder features the following depressive and hyperarousal symptoms:

• Restlessness and trouble concentrating
• Low mood, irritability, and crying
• Feelings of guilt or worthlessness
• Loss of hope
• Appetite changes 
• Low self-esteem
• Social withdrawal or loneliness
• Elevated mood and high energy
• Impulsivity
• Grandiosity
• Racing thoughts
• Increased sociability
• Excessive physical activity
• Increased speech production

However, it can be valuable to ensure symptoms are treated to prevent cyclothymia from worsening. Other challenges, such as ADHD, sleep disorders, and substance use challenges, often accompany cyclothymia.

Persistent depressive disorder (PDD) 

Persistent depressive disorder (PDD), previously referred to as dysthymia, is a chronic state of depression that lasts for at least two years in adults and one year in children and adolescents. Many people with PDD may view their depressed mood as a personality trait and fail to recognize that it is a disorder.

Symptoms of dysthymia

Symptoms of persistent depressive disorder include the following: 

• Significant changes in weight
• Loss of enjoyment of daily life
• Mood changes
• Fatigue
• Insomnia
• Low self-esteem
• Poor concentration and decision-making
• Feelings of hopelessness

Genetics might also play a role with dysthymia, but its significance may require further study. Dysthymic disorder is also associated with other psychiatric comorbidities like anxiety, personality, and substance use disorders. 

Seasonal affective disorder

Seasonal affective disorder is a form of cyclical depression that may be linked to a lack of natural sunlight and vitamin D. In parts of the world where the winter is harsh and the sun is not present as often, seasonal affective disorder may be more common.  

Due to these inciting factors, seasonal affective disorder may have less to do with genetics and more with the part of the world people live in. Sunlight boosts vitamin D, and a lack of this vitamin can contribute to symptoms of depression. 

Symptoms of seasonal affective disorder

Common symptoms of seasonal affective disorder can include the following: 

• Prolonged low mood
• Anxiety
• Low energy
• Excessive sleeping
• Anger
• Changes in appetite
• Irritability
• Loss of motivation
• Dread about the future
• Feelings of unfounded guilt

Menstrual cycle-related mood changes and premenstrual dysphoric disorder (PMDD)

Throughout the menstrual cycle, hormones called estrogen and progesterone fluctuate. These hormonal fluctuations can impact neurotransmitters like serotonin, which can affect mood. Premenstrual syndrome (PMS) commonly occurs during a week or two prior to the menstrual period and may involve low mood, irritation, and physical symptoms like cramps and bloating.

Meanwhile, premenstrual dysphoric disorder (PMDD) involves the brain responding abnormally to normal hormonal shifts during the luteal phase of the menstrual cycle. It’s considered a severe negative reaction in the brain and can lead to symptoms like suicidality, overwhelming anger, depression, and severe anxiety. These symptoms often significantly affect daily life and the ability to function normally. While PMDD can resemble a mood disorder due to the mood instability associated with it, it’s seen as a cyclical hormonal pattern since it is directly linked to hormonal shifts.

Cyclical depression vs. bipolar disorder

Cyclical depression can refer to multiple conditions, but it’s often viewed as a less severe form of bipolar disorder, which is characterized by alternating depressive episodes and hypomanic or manic episodes. Cyclothymia (one disorder falling under the umbrella of cyclical depression) typically involves depressive episodes and hypomanic episodes that aren’t severe enough to warrant a bipolar disorder diagnosis.

Common signs and symptoms of cyclical depression

Below are a few common signs of cyclical depression:

• Depressed mood
• Difficulty falling asleep
• Loss of interest in previously enjoyed activities
• Social withdrawal
• A sense of worthlessness

Symptoms tend to come and go in a cyclical pattern and can contribute to significant distress.

Root causes and risk factors

Like many other mood disorders, including major depressive disorder, cyclical depression doesn’t necessarily have one root cause. Instead, multiple risk factors typically combine and lead to symptom development. Potential risk factors include the following:

• Genetic and biological factors
• Hormonal changes
• Traumatic events and stressors

A person’s family history and any prior mental health concerns can also impact the likelihood of them experiencing cyclical depression. 

How cyclical depression is diagnosed

To diagnose cyclothymia or another type of cyclical depression, a mental health specialist might ask questions about your symptoms, their frequency, and any patterns you’ve noticed. They may also rule out any bipolar and related disorders by asking about whether you experience any emotional highs or display risky behavior. Symptoms tend to help mental health professionals understand what type of mental health disorder you could be living with, so it can be crucial to remain open and honest when seeking support.

Avoiding self-medication and substance use: Helpful coping strategies between cycles

People with depressive disorders may sometimes seek to alleviate their severe symptoms via substance use. This is sometimes referred to as self-medicating.

If you use alcohol to cope, it may be helpful to note that this substance is a depressant that can lead to long-term low moods. With consistent and heavy use, some people also develop alcohol use disorder (AUD), which may require treatment

Helpful coping strategies to reduce mood instability and promote mental well-being may include the following:

• Practicing good sleep hygiene, such as going to bed and waking up at the same time each day, to reduce difficulty falling asleep
• Exercising regularly
• Fueling your body with nutritious foods
• Using grounding exercises when stress and challenging emotions arise
• Spending time with loved ones
• Engaging in hobbies you enjoy

Treatment options for cyclical depression and other depressive disorders

There are many forms of treatment for depressive disorders. The following are the most  widely used and effective treatment options. 

Therapy

Various forms of therapy may be effective if you have cyclical depression. Common therapy options include cognitive behavioral therapy, psychodynamic therapy, and interpersonal therapy. Many clients find talk therapy valuable in treating mood shifts and depressive episodes. However, some forms of treatment may differ, depending on your diagnosis. For example, seasonal affective disorder is linked to a lack of sunlight. One popular treatment method is taking Vitamin D supplements in conjunction with light therapy. Consult your healthcare provider before trying a new therapy or taking new supplements. 

If you aren’t sure what to address in therapy, talking about your feelings may be a relief. Your therapist can guide you through helpful strategies, activities, interactive assignments, and guided questions if it helps you. In addition, there are over 400 therapeutic modalities that clients can try, so if one doesn’t work for you, there may be another that is effective. Talk therapy, whether in-person or online, may help you address the root causes of your mental health challenges.

Prescription medication 

Medication is sometimes prescribed as part of a comprehensive treatment plan for depressive disorders. Be sure to discuss any medications you’re currently taking with your doctor and ask about any potential side effects. Never start, stop, or change the way you take medication without consulting your prescribing provider.

When to seek support immediately

You may need immediate help if:

• You are experiencing hallucinations or delusions

• There is a risk you may hurt yourself or someone else

• You’re displaying a sudden, extreme change in behavior

• You’re unable to function due to your mental state

These concerns can point to severe illness that requires evidence-based, effective treatment. The National Institute for Mental Health provides various resources to help individuals seek support.

Counseling options 

If you are experiencing symptoms of cyclical or chronic depression, reaching out to a therapist for support may be beneficial. Many people find that online depression therapy is an effective option for addressing symptoms of depression, as it can be attended from home via your choice of video, audio, or live chat.

Online therapy for depression and other mental health conditions

Many people with depressive disorders struggle with tasks like setting up appointments and following up on phone calls. If you can relate to this difficulty, consider contacting a therapist through a platform like BetterHelp, which can simplify the process.

Research suggests that online cognitive behavioral therapy (CBT) for depression is at least as effective as face-to-face CBT. Both in-person and online options can provide quality care.