What is the difference between a mood swing and a mood episode?
Everyone has ups and downs. A hard morning can turn into a good afternoon. The American Psychiatric Association describes everyday mood changes as typically lasting hours rather than days, without extreme changes in behavior or trouble with daily routines.
A mood episode is a longer, more intense period. According to the National Institute of Mental Health (NIMH), symptoms during an episode last every day for most of the day, and they come with changes in behavior, energy or activity that others can notice. The table below shows the general contrast. It is for understanding, not for diagnosing yourself.
| What to look at | Ordinary mood change | Mood episode |
|---|---|---|
| How long it lasts | Typically hours | Days to weeks, often a week or two or longer |
| How much of the day | Comes and goes | Most of the day, every day during the episode |
| Energy and behavior | No extreme change | Clear change in energy, activity or behavior |
| What others see | Usually nothing unusual | Changes that are noticeable to other people |
| Daily life | Routines keep going | Can disrupt work, school and relationships |
What are mania and hypomania?
Mania is the high end of a mood episode. NIMH describes a manic episode in bipolar I disorder as lasting at least 7 days, most of the day and nearly every day, or being so severe that hospital care is needed. It is not simply being in a great mood, and it can show up as extreme irritability rather than happiness.
Hypomania is a less severe form. The American Psychiatric Association says the symptoms need to last only four days in a row, and they do not lead to the major problems in daily functioning that mania commonly causes. Common signs of both include:
- Feeling very up, elated, or unusually irritable or touchy
- Needing much less sleep and still feeling full of energy
- Racing thoughts, or talking fast and jumping between topics
- Being far more active than usual, or starting several projects at once
- Feeling unusually important, talented or powerful
- Risky or impulsive choices, such as spending sprees or reckless driving
What does the low side of bipolar disorder look like?
Depressive episodes in bipolar disorder typically last at least 2 weeks. A person may feel sad, indifferent or hopeless, lose interest in almost everything, feel slowed down or restless, and have trouble concentrating or making decisions. Sleep can swing either way, with trouble falling asleep, waking too early, or sleeping too much. Some people have thoughts of death or suicide.
Many people also have stretches of steady mood between episodes, and the NHS notes these can last weeks, months or years. Cyclothymic disorder is a different pattern: many periods of milder high and low symptoms over at least two years that do not reach the level of full episodes.
Why do many people first ask for help during a low?
The lows hurt, and the highs often do not. The American Psychiatric Association notes that people with bipolar II disorder often first seek treatment because of depressive episodes, since hypomanic episodes can feel pleasurable and may even improve performance at work or school. NIMH adds that hypomanic episodes may go unnoticed, and some people live with bipolar disorder for years before it is diagnosed.
So if you ask for help with depression, it is worth mentioning any past periods of unusual energy, even good ones. Our guide on why bipolar disorder can look like depression explains the questions a provider usually asks.
What else can cause big changes in mood?
Large mood changes do not always point to bipolar disorder. NIMH notes that some health conditions, such as thyroid disease, can cause similar symptoms, and that some prescribed, recreational or illicit drugs can mimic or worsen mood symptoms. Other mental health conditions can overlap as well, which is one reason the NHS says bipolar disorder can take time to diagnose.
A good evaluation looks at your whole history rather than one bad week. NIMH says bipolar disorder is diagnosed based on the severity, length and frequency of symptoms over a lifetime, along with family history. A provider may also suggest a physical exam or medical testing to rule out other illnesses.
How can I track my moods before a visit?
NIMH suggests keeping a life chart or mood journal to help recognize mood swings. It does not need to be fancy. A few lines a day in a notebook or phone can show a pattern that is hard to remember from memory alone. Try noting:
- Your mood that day, and whether it held or shifted within hours
- Hours of sleep, and whether you felt tired or wide awake after little sleep
- Energy and activity, including new projects or unusual spending
- Alcohol, drugs, caffeine, and any new medications or supplements
- Anything a friend or family member said they noticed
When should I ask for an evaluation?
The NHS advises seeing a health care provider if you have extreme changes in mood that last a long time or affect your everyday life. Other reasons to ask include a pattern that keeps coming back, people close to you saying you seemed unlike yourself, or a parent or sibling with bipolar disorder, since it often runs in families. Sleep changes can be an early clue, so our guide to sleep problems and mental health may also help.
You do not need to be sure what is going on before you ask. Treatment helps many people with bipolar disorder, and NIMH says symptoms usually do not go away on their own, so an early conversation has real value.
What does an evaluation look like at this clinic?
At DanShalom Behavioral Clinic, a first psychiatric evaluation takes about 60 minutes with Victor Onodjacha, MSN, PMHNP-BC, a board-certified psychiatric-mental health nurse practitioner. His main areas of experience are ADHD, anxiety, depression and bipolar disorder, and our page on bipolar and other mood disorders describes care for this group. Visits are in person in Sugar Land or by secure video if you are physically in Texas, Idaho, Arizona or Maryland. We see patients ages 5 to 65, and a parent or guardian must be present for anyone under 18.
Bring your mood notes if you have them. Medication may or may not be part of what you discuss. Any decision comes after the evaluation, not every medication can be prescribed at every kind of visit, some may need an in-person appointment, and we explain what applies to you and how medication management works. Coverage details are on our insurance page, and you can request an appointment online.
If you are in crisis, call or text 988, or call 911 if there is immediate danger. DanShalom Behavioral Clinic is not an emergency service.
When to seek urgent or higher-level care
An outpatient clinic is the right place for evaluation and ongoing care. It is not the right place for an emergency. Get help right away if you or someone you care for:
- Thoughts of suicide or of harming yourself or someone else
- Seeing or hearing things others do not, or holding beliefs that seem out of touch with reality
- Going with very little sleep while behavior becomes risky, such as reckless driving or huge spending
- Being unable to eat, get out of bed or take care of yourself
Call or text 988 (Suicide & Crisis Lifeline), call 911, or go to the nearest emergency room. More crisis resources
Questions patients ask
Does being moody mean I have bipolar disorder?
Not by itself. Most mood changes are part of ordinary life, and they usually pass within hours. Bipolar disorder involves distinct episodes with changes in energy, activity and functioning that last days to weeks. Only a clinical evaluation can say what your own pattern means, and it may point to something else entirely.
Can irritability or anger be part of a mood episode?
Yes. A high episode does not always look happy. NIMH and the American Psychiatric Association both list extreme irritability as a possible feature of mania. Irritability has many possible causes, though, including stress, poor sleep and depression. What matters is how long it lasts and what comes with it, so describe those details to a provider.
If I feel great and get a lot done, why would anyone worry?
Hypomania can feel very good, and a person may not feel that anything is wrong. Family and friends may be the ones who notice a change. The National Alliance on Mental Illness explains that the high of mania does not stop at a comfortable level and can become irritable and unpredictable, so a clear change from your usual self is worth mentioning.
Does bipolar disorder run in families?
It often does. People with a parent or sibling with bipolar disorder are more likely to develop it, but many genes are involved, and not everyone with a family history develops it. NIMH notes that one identical twin can develop it while the other does not. Tell your provider what you know about mood conditions in your relatives.
Can children or teens have mood episodes?
NIMH says symptoms most often begin in late adolescence or early adulthood, and that children occasionally have them. The National Alliance on Mental Illness notes that diagnosis in children has been controversial and calls for a comprehensive evaluation of physical and mental health first. Everyday teen moodiness is common, so raise any lasting change with a provider rather than assuming either way.
References
Reviewed by Victor Onodjacha, MSN, PMHNP-BC, . This page is general information, not medical advice or a diagnosis.