Mood Swings Without Mania

last updated 3/23/24

Many people have mood swings without mania: more than plain depression, but not “bipolar disorder”. Their depressions fall in the middle of a spectrum of mood problems that extends from plain/pure depression to depression with manic episodes.

Mid-spectrum depressions can be made worse by antidepressants, so it’s important to know: “where on the mood spectrum is your depression?” (Take the MoodCheck questionnaire for help answering that).

Mid-spectrum mood problems have several features that distinguish them from plain or pure depressions, as follows.

Swings

Just having depressive episodes that come and go is a marker for being in the middle of the mood spectrum. Or there can be “ups”, as well — from subtle to obvious. Obvious ups are called “hypomania”, described next. Some people live “up” except for their downs; this is called “hyperthymia” with depressions; more on that below also.

Hypomania

Some people, often right before a big down, can have “hypomania”, literally a little up (versus a big up — that’s manic). Hypomania can be so subtle it just looks like “having a really good day”. Or it can be noticeable to others, who might think you are not your usual self.

Hypomania is a high-energy state: talking fast, thinking fast, lots of ideas, often very creative, more social than usual, more impulsive (“let’s go to the beach!”). It’s not dangerous, by itself (whereas mania can be: lost jobs, lost relationships, lost savings).

Many people don’t recognize their own hypomania — because to them, it’s not “abnormal”, it’s just a really good day. Their loved ones or co-workers might notice it. A questionnaire designed to catch hypomania, like MoodCheck on this site, is often more informative if filled out by family or a close friend.

More about hypomania.

Other mid-spectrum markers

Some people who will have bad reactions to antidepressants (becoming agitated, anxious, irritable, unable to concentrate — mixed state symptoms) do not have hypomania, or hyperthymia or obviously repeating downs. They might eventually have repeated downs but perhaps they “cycle” slowly; or perhaps their depression is their first but more will follow. How might these people be identified as being “mid-spectrum”? Answer: four other features.

1. a close relative with bipolar disorder, or a related condition like schizophrenia or repeated depressions.
2. early onset of depression: late teens to early 20’s (because plain-depression onset tends to be later). 
3. many episodes of depression, especially short ones (days to weeks); and post-partum depression.
4. “antidepressant misadventures“: something really weird happened when an antidepressant was started. Like agitation, anger, anxiety, attention problems or extreme insomnia. 

Having any one of these markers raises the chance of one a bad reaction to an antidepressant. Having several markers raises the chances further — even without a history of hypomania.

Mixed states

When depression is combined with high-energy symptoms like anxiety, anger, agitation, attention problems, or extreme insomnia, this is called a “mixed state“. Antidepressants can cause mixed states, or make them worse.

Unfortunately, the following conditions, when combined with depression, can create symptoms that look just like a Mixed State:

• trauma (PTSD)
• hyperactivity problems (ADHD)
• anxiety problems (like “Generalized Anxiety Disorder”, GAD)
• relationship problems (“borderline”)

However, there are clues to tell them apart, namely the mid-spectrum markers above: family history, age of depression onset, episodic course, and antidepressant misadventures. For more on this diagnostic challenge, see PTSD, ADD, GAD, borderline — or mixed state?

Key Reference

The “spectrum” approach to diagnosis used to be somewhat controversial (mostly because it can see seen as rather opposite the official rule book for diagnosis, the DSM). Now the spectrum approach is recognized to much more closely match reality and the two approaches are commonly viewed as complementary. For more details, see the DSM versus spectrum diagnosis of mood problems page. Skeptics are referred to Figure 3 in the most recent mood disorder guidelines, which looks like this:

:

Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry. 2021 Jan;55(1):7-117.