By Thomas L. Schwartz, MD
Do you suffer from mood swings? Most of us do from time to time. However, if you have excessive mood swings that interfere with your life and cause distress, then you might have a diagnosable mental or emotional problem. Unfortunately, mood swings portrayed in the media are often labeled as bipolar disorder and may not give a fair representation of this illness. Bipolar disorder is the same as manic depression. Bipolar disorder patients certainly have mood swings but these have to be differentiated from many other types of mood swings… Below are some simple strategies to better determine if you suffer from a bipolar disorder or not.
1) We all have mood swings! First of all, if you haven’t suffered a mood swing you may not be normal. When stressful things happen to us we certainly may get more angry and more irritable, more quickly. If good things are happening to us, we are more likely to be excited and extra happy. These are normal variations in mood.
2) Some of us have too many mood swings all the time… Some people state that they are overly emotional or sensitive. They can become angry and combative at the drop of a hat or burst into tears for apparently no good reason. Often times, these people are at the mercy of their environment and what is going on around them. When mildly good things happen they have upward mood swings to the extreme and when mildly bad things happen they have downward mood swings to the extreme — even to the point of becoming suicidal. Some people have mood swings triggered by certain psychological situations such as the fear of abandonment, the fear of being criticized or put down. These often trigger severe mood swings. These types of mood swings are not bipolar or manic depressive in nature. These long-standing rapidly changing moods are more likely the result of a personality style and coping style. Here, psychotherapy is likely one of the best treatments, not medications. In these situations, patients have to learn to monitor their social situations, stress levels, and psychological patterns and eventually learn to control excessive mood swings.
3) Less often, patients will have clinical bipolar disorder. In my experience, bipolar disorder mood swings are a little bit different than the ones noted above. Bipolar mood swings are a bit more sustained and last much longer. Bipolar patients do not swing their moods every hour or every other day for the most part. Instead, depression may go on for weeks to months, or the mania (happy, euphoric, energetic states) may last from a few consistent days to several weeks as well. Bipolar patients are more consistently up at one time or more consistently down. To make an accurate diagnosis of bipolar disorder, we look for distinct sustained depressed moods and distinct sustained elevated moods instead of the rapidly shifting stress-induced or personality induced mood swings noted above. Medications seem to be much more effective in treating true bipolar disorder mood swings in comparison to mood swings due to other reasons. The key to successful treatment is making an accurate initial diagnosis and choosing the appropriate psychotherapy and/or medications to get the patient better.
Hopefully these tips will help obtain better outcomes for doctors and patients alike.
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Thomas L. Schwartz, MD is associate professor of psychiatry, director of adult outpatient services, and assistant director for psychiatric residency training at SUNY Upstate Medical University, where he also directs the Depression & Anxiety Disorders Research Program. Schwartz also maintains a private practice and consults for the Indian Health Service, the Neuroscience Education Institute, pharmaceutical companies, and associated industries. He is the author of Depression: Treatment Strategies and Management, 2nd Ed.