Psychotherapeutic treatment can cure cyclothymic disorder

In the current issue of Psychotherapy and Psychosomatics a group of Italian investigators headed by Giovanni Fava (University of Bologna) published a randomized controlled trial on psychotherapeutic treatment of cyclothymic disorder, a disturbance that is characterized by rapid alternation of mood swings. "These patients can change mood in a matter of hours, moving from being cheerful and warm to be irritable and blue, without reaching the prolonged states of bipolar disorder" explains Professor Fava. "This is a neglected disorder since there is no approved drug treatment for it. It is attributed to temperament, something you cannot do anything about it. But we discovered something else".

There is a lack of controlled studies of psychological treatment of cyclothymic disorder. The aim of this investigation was to examine the benefits of the sequential combination of cognitive behavioral therapy (CBT) and well-being therapy (WBT) compared to clinical management (CM) in DSM-IV cyclothymic disorder. Sixty-two patients with DSM-IV cyclothymic disorder were randomly assigned to CBT/WBT (n = 31) or CM (n = 31). Both CBT/WBT and CM consisted of ten 45-min sessions every other week. An independent blind  evaluator assessed the patients before treatment, after therapy, and at 1- and 2-year follow-ups. The outcomes included total score of the change version of the Clinical Interview for Depression, and the Mania Scale. All analyses were performed on an intent-to-treat basis. Significant differences were found in all outcome measures, with greater improvements after treatment in the CBT/WBT group compared to the CM group. Therapeutic gains were maintained at 1- and 2-year follow-ups. A sequential combination of CBT and WBT, which addresses both polarities of mood swings and comorbid anxiety, was found to yield significant and persistent benefits in cyclothymic disorder.

In an accompanying editorial, a leading expert in mood disorders, Professor Ross Baldessarini (Harvard Medical School) outlines the importance of these new findings. According to him, as the complexity and subtyping of mood disorders continue to grow, there is increased challenge to support the concepts epidemiologically and clinically, with a particular need to improve matching of phenotypes with genetic and other biological assessments. "We discovered that cyclothymic disorder is essentially an abnormal reactivity to environmental stimuli. By decreasing the level of anxiety and tension and by increasing  psychological well-being these mood swings may fade away" concludes Giovanni Fava. "There is a lot to be done, particularly in troubled adolescents".