Can a Person See Their Mood Swings Coming?
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Q:  With bipolar/mood swings, is the person aware of the mood swings coming on before they happen? 

Dear John -- 
Interesting question.  Since there are so many different variations on "swings", I suspect no single answer applies.  Perhaps we could phrase it:  "is it possible for some people to see some of their swings coming?"   That answer is clearly yes.  With practice most patients can learn to see signs of trouble, especially things like decreased sleep.  One of my patients can tell if he's just got a little too much to say in an email reply, or too many really great ideas on what the company should be doing.  At that point he's learned to turn up his Depakote 125mg, just a little teeny bump up.  He calls it "having his ear to the rail".  He's had psychotic periods and gotten himself in big trouble during those episodes -- so he has a very great incentive to watch closely for changes that look to be heading in that direction (and in between episodes, he's just a smart guy with no symptoms, which makes it easier). 

At the other end of the spectrum, there are folks who are not aware of their mood swings even while they're in them, so obviously there's no chance for prior awareness there.  Which end of the spectrum is most common?  I see lots of both ends, but in my position there's a tendency toward over-representation of the no-insight end of things, especially for inpatient psychiatric unit work.  I suspect there's a very broad spectrum of "insight", and that the degree of insight can vary quite a bit even within the same person. 

Complicated, isn't it?  Sorry I can't give you a more direct answer. 

Dr. Phelps 

Published April, 2003


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