A 22-Year-Old Female College Athlete With Wild Mood Swings

Claudia L. Reardon, MD


June 17, 2022

For the management of cyclothymic disorder, a combination of psychotherapy and medication is often warranted. Common types of psychotherapy for this disorder include cognitive-behavioral therapy and interpersonal and social rhythm therapy. No medications have been approved by the US Food and Drug Administration (FDA) for cyclothymic disorder. However, options may include medications that are typically used to treat bipolar disorder, including mood stabilizers; antipsychotic agents; and, with caution, antidepressants.

In this patient, lamotrigine was started, and the dosage was gradually titrated to 200 mg daily. Lamotrigine is a mood-stabilizing medication that is commonly used in bipolar disorders and, by extension, may have utility in cyclothymic disorder. It is particularly established as a treatment and a preventive measure for bipolar disorder depressive episodes. Thus, it may not fully protect against hypomanic symptoms in cyclothymic disorder. Lamotrigine has a lower expected side-effect burden than many other medications for bipolar disorders.

This patient also engaged in interpersonal and social rhythm therapy. The combination of medication and psychotherapy allowed her to establish regular daily rhythms that helped to stabilize her mood and to avoid destabilizing triggers.


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