by Donald Kern,MFT


      He sat there in the chair, propped up on one elbow, slouched in the seat. He looked like a deflated elf, his round eyes sunken in their sockets, his skin a gray pallor. “I don’t know what happened”, he said. “Two months ago I was on top of the world. There was nothing I couldn’t do. My wife says now she can’t understand how I was able to function on 3 hours sleep and still have boundless energy. I never felt so good in my life. Now it all seems beyond me. I feel like I’m on a roller coaster and I’ve become stuck at the bottom of a high ride, a bottom I can’t seem to shake. I’d rather not be alive if it means living with this sense of hopelessness and futility. What’s wrong with me,Doc? I can’t stop crying.”

     I hear this story in various degrees and shades of emotion all too often. My client is talking about mood changes which seem to have a life of their own. They stem from no particular losses or grievances which might explain his sense of acute melancholia. What further complicates this picture is the alternation of moods, the ever irrepressible High of boundless energy, the sharp drop into apathy. What is happening here?

     There are several variations and explanations by which we can understand dramatic mood changes. Are we , for instance, talking about a swing in mood from our normal, everyday “OK”state, into a depressive state. Or , is there also the presence of sharp spikes in energy, characterized at it’s extreme by a grandiose, inflated sense of self. As well, there are degrees of intensity to take into account.

     The sinking into despair is what is termed a clinical Depression. It may occur in response to a crisis or significant life event, run it’s course over a matter of weeks or months, and in time recede into the past. Sometimes there may be no apparent stressor. What we have recently come to understand is that there may be a chemical imbalance which is triggered by some kind of stressful occurrence. Depression appears to run in families.

     Of further concern is the fluctuating of mood between intense “highs”called Manias along with a cycling into depression. This is termed Manic Depression or , Bipolar Disorder. In it’s extreme it can be highly debilitating and like depression, lethal. Mania can result in acute thought dysfunction, impairing a person’s ability to think logically. As well, one may become involved in highly questionable schemes, financial &/or personal, resulting in financial repercussions, promiscuity and brushes with the law.

     There are milder versions of heightened mood fluctuations termed Cyclothymia and Hypomania. Cyclothymia is a fluctuation or cyclic alternation of mood, without the intensity of it’s more severe cousin, Bipolar Disorder. Hypomania is a heightened state of energy - filled expansiveness less severe then Mania. It often feels enhancing with a sense of productiveness, while having less of a downside , at least on the surface. Mania and Hypomania are quite seductive. They often involve such a sense of powerfulness and confidence, that one becomes caught in expansive well being , the abrupt deflation of which seems all the more cruel. Like other Mood Disorders, there appears to be a Genetic link(it runs in families).

     Our understanding of the causes and biochemical underpinnings of dramatic mood shifts has increased in the last 20 years. We know that once established , Mood disorders are more likely to persist and grow worse. This is called “Kindling”. Studies show that the sooner a Mood disorder is treated, the greater the chance for a complete recovery. Virtually 75% of those effected can be treated successfully, either with complete cessation of symptoms or a significant reduction.

     What does one do when he finds himself in a dramatic mood change, or more commonly, when he sees a friend or family member in the throes of one? Mood disorders are often discounted by those afflicted. How do we come to know what we are seeing is dysfunctional, and what do we do?
Here are some thoughts on how you can help:

• Recognize symptoms early on by noticing changes in sleep, appetite, grooming, belligerence
  and isolating behavior.
  
  
• Maintain a supportive atmosphere. Avoid confrontation through speaking calmly in the face
  of agitation. Project an attitude of concern.
  
  
• Fill in for patient’s lack of emotional control by overcoming denial, yours and theirs.
  
  
• Often a family meeting is helpful. Be sure to point out strengths to help gain common ground.
  
  
• Set boundaries and limits, It’s important to let a family member or friend know there is a
  structure, a support to make up for their lack of control. Reduce their sense of turmoil.
  
  
• Join a support group. Being connected with others who share your concern helps normalize
  your situation. It also serves as a source of advice and knowledge, often from others who have
  trod the same road as you.
  
  
• Seek treatment. Today there are medications and treatments which can dramatically change
  hopelessness into hopefulness. A combination of medication and psychotherapy has been found
  to be the most effective, successful combination in treating mood swings. Seeking treatment helps
  reduce isolation and a sense of stigma.