Dear Patti,

My brother Lucas and I are 21 months apart. I’m the younger one. My friends and I have always joked that Lucas is manic-depressive because he’s always kind of up and down in his moods. I never know what he’s going to be like from one moment to the next. He may be happy and fun to hang out with for a week and then all of a sudden he’ll get sad and depressed and not want to do anything at all, even though nothing bad has happened. I’ve resented it for years because deep down I felt like Lucas could control it if he really wanted to but I thought he just wanted attention.

Friends have said that Lucas is my parents’ favorite because he’s a boy and I’m a girl. I don’t believe that. I know my parents love both of us equally, but it doesn’t always feel that way. I usually have to take a back seat because Lucas is such a handful and my parents get really stressed about him. His grades are up and down and he’s run away twice, which was really scary for the whole family.

This year he fell in love with a girl for the first time and was crazy about her. They were together all the time and he talked about their love constantly. Then out of the blue Lucas broke up with her. He immediately became depressed and wouldn’t come out of his room or talk to anyone. The broken hearted girl kept calling me asking what she did wrong. I didn’t have a clue.

Finally my parents insisted Lucas get a complete psychiatric work-up. To my surprise, Lucas was diagnosed with cyclothymic disorder. He is now taking medication and going to therapy twice a week. I was shocked because even though sometimes I teased him and called him crazy, I never really thought there was anything wrong with my brother. I thought he was just selfish and spoiled. Now that I know Lucas has a real problem I feel sad and a little guilty. I want to help him if I can. Could you tell me more about cyclothymia? My family had never even heard of it before Lucas was diagnosed.

— Claire


Dear Claire,

While I understand your regret about your natural frustrations toward your brother, there was no way for you to know about his disorder. Rather than feeling guilty, I support you wanting to focus on understanding his disorder and learning more about how you can help Lucas.

Cyclothymia is a milder form of bipolar disorder and brings about mood changes that alternate between depression and mania. It’s not as severe as bipolar disorder and patients who suffer from it usually don’t need inpatient care or experience psychotic symptoms. Your brother isn’t alone. The American Psychiatric Association estimates that cyclothymic disorder affects between 1.2 million and 3 million Americans. Treatments for cyclothymia include psychotherapy with a trained professional specializing in treating mood disorders, medications referred to as mood stabilizers, or a combination of psychotherapy and medication.

As your brother has probably experienced, cycling from one mood to the other can happen suddenly and last for hours or sometimes days. At first he might feel downcast and empty to the point that life seems hopeless and bleak. Then a rapid shift of mood may occur that causes him to feel euphoric, energized, or even compelled to engage in impulsive behavior with risky consequences. People struggling with cyclothymic disorder can come across as moody, dramatic, and unpredictable, which can be very difficult for their loved ones.

Encourage Lucas to keep daily records as a way of monitoring his mood swings, activities, and interactions with others. Charting can help identify warning signs that come right before a manic or depressive episode. With the help of his therapist, he’ll be able to recognize what types of social and interpersonal interactions contribute to his mood changes. A plan can then be developed to avert the escalation of his symptoms.

It’s important to remember that your brother can’t control his mood swings by simply willing them to go away. Nor is it effective for family members or friends to scold Lucas and tell him to “snap out of it.” The more you learn about cyclothymia, the better you’ll be able to understand what he’s going through. Have as much patience and empathy as you possibly can — but don’t lose your own sense of self in the process.

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has an office in Pasadena. Contact her at (626) 584-8582 or email Visit her website,