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Expert Q&A

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Are mood swings a sign of depression?

Asked by Betty, Texas

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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.

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

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.

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