All of sudden our mood can change from good to irritated – and maybe even to angry.
During a presentation at the 2008 Women’s Health Matters Forum & Expo in Toronto, Women’s College Hospital psychiatrist, Dr. Anthony Levitt, said that ‘mood swings’ is such a commonly used term that probably 90 percent of the audience would say they have had a mood swing in the last 24 hours.
However, mood swings are a very different thing when they are associated with a mental illness, and they should not be ignored.
Mental illness and mood swings
When associated with a psychiatric condition, mood swings can be overwhelming. The two most common types of mood swings are mood changes (such as irritability), and anger attacks.
‘These changes can be devastating, for both the individual and for the people closest to them,’ Levitt said.
Mood changes can be a prompted by any number of situations, and refer to true changes in the person’s emotional state. Anger attacks are a sudden expression of negative emotion and are typically a response to something that has just happened.
When it comes to mental illness, the three most common causes of mood swings are:
- Depression
- bipolar disorder
- premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).
More than feeling a little blue
When someone is suffering from depression, irritability can be the sole mood change – but it can have a terrible impact, Levitt said.
Quite often, the depressive person’s irritability will be directed at those in closest contact, such as family and friends. The problem is that we all experience irritability and it can be hard for the recipient of the behaviour to step back and be objective. We really want to say, ‘Pull your socks up, we’ve all been irritated and we deal with it.’
But for the person who is depressed, irritability is like a ‘churning engine’ that is hard to stop, Levitt said.
‘It’s unfortunate. Irritability is terribly ignored as a symptom of depression.’
Anger attacks occur in two-thirds of people with depression but it is only in the last 10 years that they have been explored in the scientific literature. However, people who have anger attacks typically have the most severe from of depression, Levitt said.
Once again, though, it’s a symptom that can exacerbate depression by alienating loved ones, disrupting families and possibly leading to a higher risk of suicidal thoughts, partly as a result of the alienation.
Treatment includes cognitive behavioural therapy (connecting feelings to thoughts) and interpersonal psychotherapy (dealing with interpersonal relationships).
Medication can successfully treat depression and its related symptoms, but medication can also cause irritability. These effects should be carefully monitored by a physician and patients should be aware of their mood changes, Levitt said.
Bipolar disorder
Bipolar disorder is characterized by intense mood swings between mania and depression. Unlike the portrayal in popular press or movies – of mania as a heightened happy mood – it’s not. It is often very uncomfortable and associated with intense irritability, Levitt said.
Bipolar disorder can be one of the most complicated mental illnesses to treat because the symptoms can mimic other physical illnesses, making it important to rule out all possible causes before a diagnosis of bipolar disorder is made.
The most common treatments for bipolar disorder are medications, such as mood stabilizers and/or psychotherapy.
PMS and PMDD
Anger attacks are the most common mood change resulting from PMS and PMDD, and are associated with a feeling of being out of control. PMS is experienced by about 40 percent of women in their childbearing years while 3 to 5 percent of menstruating women have PMDD. Unlike PMS, PMDD symptoms are very severe and can completely disrupt the lives of women affected by it.
PMDD can be treated with psychological, lifestyle/nutrition and medication therapies.
Getting off the swing
It’s important to determine the pattern of mood swings by identifying the frequency, the duration and the severity of the epsidodes.
Levitt said it is also important to determine the fragility and changeability of mood swings. Then report all of this information to your family doctor or psychiatrist. Irritability and anger attacks are both serious and under-recognized mood disorder symptoms, but both are treatable.
