August 31st, 2010
08:39 AM ET

Are mood swings a sign of depression?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Betty of Texas: Is it possible to have mood swings where one moment you are happy, then the next you can be sad? Is this a sign of depression? I do also have ADD as well but currently am not on medicine.

Expert Answer:

Dear Betty,

The situation you describe is fairly common but it is not a very classic description for depression. Most depressed people feel unhappy all the time. Sometimes they'll feel better in the evenings or better in the mornings, but they wouldn't describe themselves as happy one moment and sad the next.

There are two psychiatric conditions that are defined in large measure by moods that shift between happy and sad.

The best known of these conditions is bipolar disorder, which is also called manic depression. Most people with bipolar disorder will vacillate between very high and very low moods. When one looks closely at these folks, one will see a lot of rapid back and forth between sadness and either euphoria or irritability, but there is a larger pattern that is usually present.

This larger pattern manifests as periods of weeks to months in which they feel predominantly depressed or predominantly euphoric, hyper or irritable (and often times all three in rapid succession).

Many people with bipolar disorder will recognize that they had unusual degrees of moodiness as children and adolescents but usually can identify a time in adulthood when the disorder really took off.

I cannot tell from your brief question whether your ping-ponging between happiness and sadness is new or has been going on for years. This is a really important question in terms of coming up with the best diagnosis.

If you do not have relatively long periods of either depression or mania/hypomania, there is another diagnosis that might be relevant to your condition, and that is borderline personality disorder.

This is a chronic condition that affects women more than men and that is characterized by rapid mood shifts between excitement/happiness and anger/irritability/sadness. These shifts typically occur numerous times over the course of a day. But most people with borderline personality disorder do not have clear manic episodes, although depression is very common.

There are other symptoms/behaviors that define borderline personality disorder and if you have many or most of these, then this is likely the diagnosis that most closely fits your situation.

People with borderline personality disorder have very intense, stormy relationships with other people characterized by a pattern of being overly idealistic about people at first, followed by disillusionment and then disgust. Part of this pattern is also a terror of being abandoned by others on one hand, and fear of being swallowed up and overwhelmed by them on the other.

Other markers for borderline personality disorder include intense anger, a pattern of risky behavior, uncertainty about one's sexual orientation, chronic suicidal thoughts and a tendency to harm oneself, typically by cutting.

So the short answer to your question is that yes it is quite possible to have very unstable moods.

I worry about your symptoms and want to really encourage you to see a mental health professional to describe your situation to him or her.

soundoff (32 Responses)
  1. samanta

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    August 31, 2010 at 09:41 | Report abuse | Reply
    • Charell

      I think it's interesting how everyone wrote long note. I think we all suffer from this in one form or another. It's documented that Abraham Lincoln and Mark Twain were often depressed and on an occasion, had contemplated taking his life. So, I say all that to say this, they dealt with it with out the lithium and other meds taken for this "condition." We all have in us the strength to crawl out of any hole either we have put ourselves in, or the holes someone else may put us in. You have a flame inside of you, turn it up.

      September 1, 2010 at 03:26 | Report abuse |
  2. Elizabeth Brown

    I respectfully suggest that a third psychiatric condition can have mood swings associated with it : agitated depression, which is considered by some psychiatrists - though not the majority, I think - to be a form of bipolar illness. A big difference is that that the maniak, which I know from my own experience of this illness, is dysphoric not euphoric: that is, one can be depressively manic. Another difference for us lucky few: while I have suffered from having my mind start to spin out of control, I am not psychotic (though some people who have serious depression are). I have observed someone in the throes of classic manic depression, and that person was entirely psychotic. Also, perhaps Dr. Raison could have mentioned if only briefly how greatly treatment can help either of the illnesses he mentioned.

    August 31, 2010 at 10:48 | Report abuse | Reply
    • T

      What you're referring to is called a "mixed state" and occurs in people with bipolar disorder type I. It occurs when people experience symptoms of both depression and mania at the same time, thus resulting in what could be referred to as an "agitated depression." Experiencing a true mixed state is an automatic qualifier for bipolar disorder type 1.

      August 31, 2010 at 12:06 | Report abuse |
  3. me

    I fit all the descriptions at varying levels and no doubt have ADD undiagnosed due to no insurance. I've never been able to hold down a job very long due to total frustration about anything and everything, and i don't know how other people can subjugate themselves enough to be brain dead enough to work at any job for more than a year. I continue to struggle to pay bills and see no end to constant crisis and struggle interspersed with brief periods of "fun". There is never peace. I love, I hate, there is no happy medium. I don't understand what its like to be normal. I have a high intelligence that has gotten me nowhere. I've not been able to turn it into cash. I get obsessed and driven to accomplish, then I get bored and tired and apathetic.

    August 31, 2010 at 13:25 | Report abuse | Reply
  4. David

    That is a very familiar description of borderline personality disorder because of the behavior I see in my wife. Her father was a successful businessman who left the family when she was 14. A brother of hers was a tean age alcoholic but turned his life around while in the military, and another brother suffers from depression and divorced his wife and mother of 3 kids after 30 yrs of marriage. My wife would become depressed and go for one to three weeks and refuse to speak with me, then one day she would be over it and be friendly like the bad period had never happened. She has quit therapy a few times and is ashamed to speak about depression and says 1/3 the country is on anti depressants so her use is normal. She has moved through the disallusion stage with me and now views me with disgust. She demanded a separation 2 yrs ago. I see a therapist, she will not, and have learned to exercise to avoid depression while enduring this stress. She now uses online dating to keep a steady stream of men complimenting her, but she has not found a man that she wants to be serious with. I am about to give up and proceed with the divorce and it will be sad. I think she is afraid to trust me or any man because her dad abandoned her, but she refuses to discuss this or theraphy.

    August 31, 2010 at 13:32 | Report abuse | Reply
    • VL

      David, I feel you pain. My relationship with my husband sounds very much like yours with your wife. I suspect my husband has been out on dating lines as well and have seen myself viewed from the idealic to the disillusioned and I now find myself in the disgust phase. I fear what comes next. I have invested everything; 1/3 of my life, my emotions, my intellict, my heart, my soul, my total financial worth into this relationship and so many people besides myself stand to lose if it falls apart. I can find many things on the disorder, the symptoms etc. but very little on how to handle it being the companion rather than the sufferer. It is so heartbreaking to invest so much and feel so totally helpless to stop it from self-destruction.

      August 31, 2010 at 14:18 | Report abuse |
    • Elena

      You practically described my soon to be ex husband's behaviour.... I could not take it any more and left him 8 months ago after 9 years together. So do you think, your wife has a borderline personality or something else? Thank you!

      August 31, 2010 at 16:55 | Report abuse |
  5. Bryan

    Of course there has to be something wrong with you and we must put a label on it and feed you meds! Ever think that maybe you are actually normal and sometimes you feel sad and other times you feel happy? If you are happy all the time then there is something wrong with you and you should seek help, you are on drugs and you should seek help, or you don't have the mental capacity to identify that sometimes your world is messed up and in which case you probably aren't reading this. Betty's question was not phrased in a manic or psychotic way-if there are more details that she left out, that would be a different story. But Betty, in my normal, non-expert, non-biased, not looking to promote myself or my ego opinion, I think you sound normal. Sometimes life sucks and sometimes that feeling lasts longer than what seems normal to you. I've always found it helpful to make a list of what is troublesome and then, right next to it, a list of what I find joy in. Hopefully your joys outnumber your troubles, but even if they don't right now, identify small steps to find more joys or mitigate your troubles. Do not let anyone tell you that it is wrong to be sad-how can you appreciate the highs without the lows?

    August 31, 2010 at 13:41 | Report abuse | Reply
  6. Laura

    From one woman to another, please do go talk with a professional, but also be aware that sometimes these things can have a dietary/lifestyle component as well that may affect hormone fluctuations and etc.. I found out this year via trial & error that my mood fluctuations (sometimes rapid and severe) were largely diet related. The moods turned out to be directly related to blood sugar and hormone fluctuations caused by a different food sensitivities. My issues totally clear up when I stick to a clean diet of: mostly unprocessed foods, restricted grains (I'm apprently somewhat intolerant), restricted sugar, cutting out artificial sweeteners, and minimizing caffeine intake to teas as well as adding in more fresh fruits & veggies. Add a bit of exercise and regular sleep (admittedly not much... unless I'm extremely stressed) and voila! Once again, talking with a professional is a great step, but discuss these options as well.

    August 31, 2010 at 14:23 | Report abuse | Reply
  7. karen

    It is also important to note that ADHD is a disorder of regulation, as is borderline personality disorder. People with ADHD have difficulty regulating their attention and level of activity, but also their moods. They often have explosive temper and irritability and rapid mood cycling, but the moods typically don't hang on as long as they might with a mood disorder such as bipolar disorder. Someone with ADHD may get angry very easily, but often can let it go after a brief time. People need to be wary of jumping to a diagnosis of Bipolar disorder or Borderline Personality Disorder because they are very severe and marked by instability in all aspects of one's life, including work, relationships, health, education, etc. It is important to see a professional for accurate diagnosis and followup with medications. Sometimes it takes a long time and several trials of medications at different dosages or different combinations of medications before stability can be reached. Therapy is an essential component of treatment to allow someone to learn about their disorder, about what triggers their moods, and how to manage their lives to reduce the impact of their disorder. Everyone has mood swings at times and there are different explanations. Not everyone has a mood disorder. There is a continuum of emotional functioning and the essential component of diagnosis and treatment is to look at the severity of the symptoms and the impact on a person's functioning.

    August 31, 2010 at 22:02 | Report abuse | Reply
  8. Betty from Houston

    Why doesn't she just get a fMRI and a PET scan, it can easily determine if she's bipolar (http://www.medscape.com/viewarticle/705207). It's a very easy test, we do it on bipolar people all the time, their neural networks just light up. Bipolar networks in the brain are very interesting to study, when it comes to depression, makes for some very nice research and case studies on these patients. Maybe the patient needs to elaborate on mood disorder as per her defined case. I think everyone normally gets moody due to lack of food, sleep, or too much stress, these are normal things. As to what bipolar is and being depressed, outside of the fMRI functional studies, I personally do not understand these illogicalities, nor the mood disorder things. In my opinion all people should be the same mood all the time, which is relaxed.

    September 1, 2010 at 02:53 | Report abuse | Reply
  9. Guest

    @Betty from Houston

    fMRI and PET do not reveal bipolar disorder just because 'their neural networks just light up' and since you are into "such nice research" seeing them light up in a person with no history of mental illness in their family would make me look for the more obvious and less fashionable diagnoses like chemical hypersinsitivity (especially if they light up with challenge)–bunch of Mengeles you all are!

    September 1, 2010 at 03:03 | Report abuse | Reply
  10. Angie

    Wow. I can't believe I am reading this today. I just today decided that I need to seek help for feeling what I assume is either borderline personality disorder or bipolar II disorder. I have tried to deal with this on my own for over 10 years and I reached a breaking point recently. I am still scared by the thought or it all but really can't stand to live like this anymore.

    September 1, 2010 at 15:29 | Report abuse | Reply
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