What Could My Mood Cycles Be
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Q:  What Could My Mood Cycles Be

Dear Dr Phelps,

 I am 21.  Since I was 18 I have suffered from cyclical dips in mood a little like PMS but happening all over the month.  (I also get PMS; my menstrual cycle is about 32 days long, the other mood dips come about every 27 days, so sometimes I get two swings a month, sometimes I get one bad one when the two coincide.)  The cyclical swings are different from my PMS in that when I have PMS I am more inclined to be irritable and mildly 'bluesy' than particularly depressed.  My PMS lasts about one day.  The odd dips last 3 days, one spent going down, one spent very depressed and feeling suicidal, one spent coming back up.  On the going down and coming up days I am usually irritable but get down if something provokes me, so that is more like my PMS.  In the past 6 months I have started noticing distinct rises from my normal mood lasting no more than 6 hours and occurring in the middle of the strange 27-day cycle (NOT in the middle of my menstrual cycle).  I get hyperactive, socialise a lot (which I don't normally do), behave in a silly way and generally act very slightly drunk.  This sounds to me like a hypomanic phase (i.e. part of bipolar II) but it can't be because it's far too short and my down swings don't last long enough to be the flip side of the bipolar coin either, and as someone who knows almost nothing about it I don't think I swing often enough to be ultradian.  Any idea what it could really be?  I had a major depressive phase after my mother died, lasting a year and a half, but I came out of it when I was 18.  It is since then that I've had these weird symptoms.  I was a 'moody adolescent' before my mother died.  When I told my doc about this he sent me for counselling because I have family problems.  That made my 'normal' phases better but didn't help the 'downs' especially the worst bit in the middle.  He's never seen me on a down because they don't last long enough for me to get an emergency appointment and they aren't predictable enough to book for, so I don't know if he believes me about how bad they are.  I haven't seen him since starting getting the 'ups'.  Thanks for reading this (sorry it was too long).

Dear Ms. I' -- 
Wow, that was an extremely well crafted description: I can see the two "cycles" like waves overlapping.  My first impulse: hand you a
mood chart to track this, if you haven't done that already, so that you could show doctors who are trying to help you what you're experiencing.  

So you've learned about ultradian cycling (for other readers, a cycling even faster than a day -- "ultra  dian" ).  Take a look at an "every 24 hours" pattern as an example of another variant (I actually saw a woman with just this pattern in my practice; she was astounded when I showed her the set of graphs on that webpage).  Then there are folks who cycle fast, but not daily, of which there are a tremendous number of variations all getting lumped under "rapid cycling".  And then of course there's the (almost all bipolar I) folks who cycle less than 4 times a year.  Anyway, the point is, there appear to be a nearly infinite number of cycling types.  And those little 6-hour blips you're getting sound sufficiently different than your "usual self" as to be very important to examine as potential hypomanic phases -- I would not discount them at all simply based on their length.  One of my patients just went into the hospital with severe cycling.  In less than 24 hours he had severe suicidal lows, but had other moment when he felt giddy and funny; and other moments when he felt extremely agitated.  Basically, he was "all over the place":  he was having elements of all the features of mania and depression, some pure, some mixed, and transitioning from one to the other in well less than 6 hours.  And it is clear now (it wasn't until all this) that he has bipolar disorder.  

So, timing of these cycles doesn't determine diagnosis, and you have alerted me to a pattern I should look for (basically, a cycle upon a cycle, even including waves that can sum with dangerous consequences).  Thanks for the clear description.  I'll close by quoting one of my favorite descriptions, from a famous researcher who herself has bipolar disorder and so can speak from experience 

"The clinical reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings. The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or "madness," to patterns of unusually clear, fast and creative associations, to retardation so profound that no meaningful mental activity can occur. Behavior can be frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish, and dangerously suicidal. Moods may swing erratically between euphoria and despair or irritability and desperation. The rapid oscillations and combinations of such extremes result in an intricately textured clinical picture." (Kay Jamison, Ph.D.)

Good luck with your continued efforts to understand these patterns. 

Dr. Phelps  

Published October, 2001


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