A 52-year-old man presents with recurrent episodes of sadness, guilt, and fatigue lasting 2–3 days, interspersed with days of mild elevated mood and impulsivity, over the past three years. Neither phase meets full criteria for a major depressive episode or hypomanic episode. What is the most accurate diagnosis?
- A Bipolar II disorder
- B Cyclothymic disorder ✓
- C Persistent depressive disorder
- D Major depressive disorder with anxious distress
Correct answer: B. Cyclothymic disorder
Explanation
Cyclothymic disorder is defined by at least two years (one year in children) of numerous periods with hypomanic symptoms and depressive symptoms that do not meet criteria for a full hypomanic or major depressive episode, with symptom-free periods of no more than two months. Bipolar II and major depressive disorder require episodes that fully meet their respective criteria. Persistent depressive disorder requires two years of low mood without the interposed hypomanic periods.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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