We all have good moods and bad moods. After all, the circumstances of our lives are always in flux. Sometimes, though, the timing, intensity, or trigger of a mood swing can signal that something else is going on.
"More and more, we're learning that people with significant mood problems also have significant health problems, and vice versa," says Ken Robbins, a clinical professor of psychiatry at the University of Wisconsin, Madison, who's also board certified in internal medicine. Recent research shows that depression, for example, can cause physical changes to the immune system and inflammation, while other health problems can trigger mood states that complicate treatment and recovery.
Mood is obviously just one of many clues to health. But when mood swings are puzzling and notable, it's worth considering possible causes. Here are five:
Possible Mood Swing Cause: Perimenopause
One day you wake up inexplicably grouchy. The next, you're sunny and bright. For a woman of a certain age -- typically the late 30s through the early 50s -- the on-ramp to menopause may announce itself as shifting blankets of feeling. Perimenopause is the biological phase, usually lasting several years, that indicates the start of menopause.
As during postpartum "baby blues," shifting ovarian hormone levels cause these life-stage mood swings.
Women with a history of severe PMS or clinical depression tend to experience the mood swings of perimenopause most, according to the North American Menopause Society (NAMS). Trouble sleeping can exacerbate them.
What else to notice: Companion symptoms of perimenopause include hot flashes, irregular periods, disturbed sleep, and vaginal dryness. North American women hit menopause (defined as having gone 12 months without a period) between 40 and 58, NAMS says.
What helps: Nonsmokers in perimenopause are sometimes prescribed oral contraceptives to level out mood, because they stabilize hormone levels.
A mild-mannered retiree flies off the handle at the slightest snag or perceived insult. A grandmother curses, quite out of character, then turns polite again. These surprising mood bumps may reflect fear and struggling in someone coping with the confusion, memory changes, and loss of sharpness that come with dementia.
The Alzheimer's Association lists mood and personality changes among the top 10 early warning signs of Alzheimer's disease, which is the number-one cause of dementia. In some people, associated brain changes can cause apathy or delusions that others misperceive as bad or strange moods.
What else to notice: Memory loss that disrupts everyday life and trouble managing common tasks like banking or driving top the list of signs of Alzheimer's. Changes worsen over time. Cases beginning as early as the 40s and 50s are on the rise.
What helps: Mention worrisome symptoms to a doctor. A complete clinical assessment for Alzheimer's can accurately diagnose the disease up to 95 percent of the time, research shows.
Perhaps the poster-child disease for mood swings is a brain disorder called bipolar disorder. That's because unstable moods are its hallmark symptom. A person tends to cycle between a normal mood state, a drastic "up" state, and a pronounced "down" state.
In the so-called manic state, the mood is unusually high and hyperactive; you may feel outgoing, restless, impulsive, distractible, and energized. Racing speech and a grandiose sense of self are common. In the depressive state, you feel persistently low, sad, weepy, or hopeless, drained of energy or interest in things or activities (including sex) that once brought pleasure. Typically each state lasts days to months, though some people cycle more quickly or slowly between these states. Some people experience a "mixed" state, in which they're beset by both a depressed sensibility and agitation and restlessness.
Scientists believe both genetics and environmental causes (such as life events) mix to cause the unstable moods of bipolar disorder.
What else to notice: The mood states of bipolar disorder tend to be unusually long and exaggerated. "But there are periods when the person is not depressed or panicky and seems just fine," Robbins says. At least half of cases of bipolar disorder begin before age 25.
What helps: A physical exam can rule out other causes; refer to a mental health specialist for accurate diagnosis and treatment (usually medication and psychotherapy together). This can be life changing, because untreated bipolar disorder can wreck relationships, impact the ability to hold a job, and increases the risk of substance abuse and suicide.
Borderline Personality Disorder
The mood swings of borderline personality disorder (BPD) are more jagged: sharp, fairly frequent, and short lived. Anger, bravado, fear, dejection, and other strong emotional shifts flicker past as often as several times a day (rather than across several hours or days, as is normal, or over much longer periods, as can be true of bipolar disorder).
Any imagined slight, a perceived threat, or any ordinary life situation can elicit an extreme and intense reaction. Inappropriate anger is especially common among people with this condition. "They have little sense of themselves, so they attach to others," Robbins says. "If you're perceived as good to them, you're good. But if you say something perceived as critical, they may rage or dismiss you." Anything that trips an underlying deep fear of rejection or abandonment can prompt the emotional swings.
A serious mental illness, borderline personality disorder's name refers to the edge of psychosis on which these fragile people live; stress can cause psychotic reactions of delusion or paranoia.
What else to notice: "Borderlines" tend to be highly impulsive and may spend a lot, binge eat, cut, drive recklessly, or abuse substances such as alcohol and drugs. Relationships are often rocky, as sufferers tend to see people as "good" or "bad," or "for them" or "against them." Not surprisingly, they're often disappointed by others or are in conflict with them. Sudden changes in school or career plans are common, according to the National Institute of Mental Health.
What helps: Psychotherapy is considered the most effective treatment for managing the destructive symptoms of borderline personality disorder. Being persistent about finding the right help is important, since it's widely misdiagnosed (often as depression or bipolar disorder).
Delirium -- a state of acute mental confusion -- is like a warning light that something's wrong in the body -- pneumonia, a urinary tract infection, dehydration, acute pain, lack of sleep.
Seeming changes in mood are one of many ways delirium can show itself, including being unable to concentrate and being unsure of reality. "Someone with delirium may seem more revved up than usual, or more drowsy and quiet," says San Francisco geriatrician Leslie Kernisan. These mental shifts can change throughout the day, so that one minute the person seems like his or her usual self, then is suddenly quite different.
What else to notice: A sudden change in mental state is the key. Especially at risk are the elderly and anyone being hospitalized (up to half of all postsurgery patients are affected). Staying with a hospitalized older adult can help minimize this common problem, which often goes unnoticed by busy hospital staff. Becoming familiar with the other signs of delirium is useful.
What helps: Alert hospital staff. They can take steps to address the underlying cause of delirium. It goes away when the stressor is eased.