Q:   Cyclothymia

My Doctor (psychiatrist) has just started me on Depakote (750 mg daily) and has diagnosed me with Bi-polar symptoms but as he puts it "Bipolar is such a generic term, I would say that you are more psycotheric".

What does psycotheric mean and how does it differ from Bipolar?

He says that since I have never had to be hospitalized for a Bipolar condition that I really am not truly Bipolar but that I am more psycotheric.

What does he mean?

Thank you,
Jeff

 Dear Jeff -- 
Your doctor has suggested that a slightly more specific version of "bipolar" describes your symptoms, namely cyclothymic.  This is generally used when people don't have symptoms so severe as to deserve a label that many people, doctors and patients alike, associate with a severe mental illness.  People think that changing to a different label will make everybody swallow easier. 

Since the treatment for cyclothymia is basically identical to that for Bipolar II, there may not be much use in the different term except for this effort to make people feel better about the label.  There are all degrees of bipolar symptoms, from basically none (in which case we'd obviously not use the label), to extremely severe.  There are people all the way along in between.  There is no clear separation between "normal" and "bipolar".  Nor is there any such separation between "cyclothymic" and "bipolar".  It's just chopping up what clearly is a continuum into different pieces.  

As you can gather, I much prefer to lump everything under "bipolar" until we have more reason and better means to separate out variations like some milder cycling your doctor is calling cyclothymia.  But, enough of that soapbox.  Suffice it to say that cyclothymia is regarded as a variation of bipolar disorder in which the depressions are not as severe as they are, technically speaking, in bipolar II; and beyond that, it's just like any other variation of bipolar disorder in terms of treatment -- as far as we know at this point.  You can find a further essay on this topic on my website, in the "diagnosis details" section.  

Dr. Phelps

Published August, 2002