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Mood Swings: Mental Health Issue or Something Else?
Erika Krull, MSEd, LMHP
Mood swings, mood instability, mood lability; whatever you want to call it, can be frustrating and difficult. When your mood is unpredictable, it can interfere with relationships, work, school, and your leisure activities. Situations you normally handle with ease can feel exhausting and overwhelming. Further, the causes of mood swings can seem like a mystery, and that uncertainty can be discouraging. That said, don't lose hope: it's usually possible to find the underlying causes of mood swings, and those underlying causes can usually be treated.
Understanding Mood Swings
It's important to recognize that mood swings are much more than just your being sensitive. They're significant, uncontrollable changes in mood that can impact your day-to-day life and are often signs of a larger issue. There's a harmful stereotype that mood swings only affect women, but the truth is they can happen to anyone. There are many causes of mood swings, including medical conditions, life circumstances, sleep problems, and psychiatric conditions. If your mood has been unpredictable recently, take the time to learn more about the medical and mental health conditions that can be causes of mood swings. This way, you can better understand your symptoms and find a treatment that helps you feel more balanced.
Identifying Common Causes of Mood
Mood swings can be an important sign of a possible medical or mental health condition. While it is normal to have some good and bad days or some degree of mood variation, if the frequency and severity are creating problems for you, it is important to receive an evaluation from a medical provider. Your mind and body may be trying to tell you something about your health.
The following are some of the most common underlying causes of mood swings:
Medical Conditions
There are several medical conditions than may be causes of mood swings. Patients with thyroid disease, particularly overactive thyroid (hyperthyroidism) may find themselves having periods of anxiety or rage that can seem unpredictable and not related to the environment. Alterations in blood sugar levels, particularly lower blood sugar, can cause anxiety and irritability. Alterations in your body's hormone levels can also be associated with causes of mood swings. In fact, the list of conditions associated with mood swings, including dementia, is very extensive and a good place to start for help is with your primary care provider, especially if these symptoms are relatively new.
Head Injury
Head injuries, even minor concussions, can another of the causes of mood swings. We know that even though a brain MRI might be normal, head injury can be associated with disruption in the architecture of nerves, which interferes with their function and changes the way nerves communicate with each other in the brain. This can lead to a loss of mood control and unpredictable mood changes. There are treatments available so if you have noticed mood problems after a head injury, it is important to seek medical help.
Stress
Worries, frustrations, an unhappiness can strain our reserves. As we become overwhelmed, we may find our tolerance starts to decline and those emotions can start to leak into other situations as mood swings. Managing stress can be key to keeping this under control. While these kinds of reactions can be normal, if the severity and frequency of mood swings becomes problematic, a therapist may be able to help you with sustaining perspective and incorporating strategies for managing stress.
Sleep Deprivation and Sleep Disorders
Our brains are very active during sleep, consolidating memories and resetting metabolic states during different stages of sleep. When we can't complete all the stages of sleep because of frequent awakenings, a sleep disorder disrupting your natural sleep stages, or inadequate sleep preventing all stages of sleep from completing, then our brains function less efficiently and this can cause mood swings. Sometimes sleep apnea or another sleep disorder can only be confirmed with a formal sleep study. If you find you have persistent difficulty with sleep or if you feel your sleep is not restful, consider reaching out to your physician for evaluation.
Substance Use
Alcohol or illicit drug use can cause mood swings through various mechanisms. Intoxication can alter brain function and decrease the efficiency of thinking, resulting in uncontrolled moods. Withdrawal can also cause abnormalities in brain function and physical discomfort. Addiction and drug seeking behaviors may impair being mentally present and result in moods that are not reflective of life events. Long standing substance use can damage areas of the brain leading to emotional leakage. All of these can be causes of mood swings.
Personality
Some people have more dynamic personalities and shift moods more easily or quickly than others. For some people, this is a harmless personality quirk. For others, it can be problematic and interfere with work, school, or relationships. If that’s the case, therapy may be useful.
Psychiatric Conditions
Some psychiatric conditions can have mood swings as a component. These can include anxiety (catastrophic thinking leading to distress and irritability) and PTSD (hypervigilance causing unpredictable anxiety and irritability). Note that while it’s common to refer to the cycling of moods in bipolar disorder as “mood swings,” rapid cycling bipolar patients have at least four mood episodes in a year, each lasting days to weeks on end. This is different than the typical hour-by-hour mood fluctuation of the mood swings outlined in this article. If you think your mood swings may be caused by a psychiatric condition, a mental health provider can help you with diagnosis and treatment suggestions.
Getting Treatment for Mood Swings
If mood swings are taking you for a bumpy ride, remember you have options. Contact your doctor to discuss your symptoms and keep searching for a treatment that helps. If past treatments for mental health conditions such as depression haven't worked, consider looking into transcranial magnetic stimulation (TMS) therapy. TMS stimulates areas of the brain involved in mood regulation—the same areas known to be underactive in those with depression. No matter what causes your mood swings, you deserve to find a treatment that works for you.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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