Dear Alice,

I'm worried that I might be manic-depressive, or bipolar-depressive, though I'm not quite sure what the exact medical definitions of those terms are. From time to time — sometimes over a couple of hours, sometimes over a couple of weeks, I can get very depressed, and everything in my life seems like it's going wrong — school, work, relationships, etc. These happen at night and during the winter more often than usual, but they happen fairly regularly all year round, for at least the last three to four years. Other times, even for weeks at a time, I'll feel fine; get really happy with certain things; not ecstatic, but happy. I also find that these depressive states can be brought on by certain things, like an argument with someone or just something that pissed me off. But then they get better, usually before I have a chance to see a counselor, and I feel silly for having felt that way at all; things seem much rosier at those times. I've seen counselors some before, but never wanted to bring it up — I was hoping they'd guess at it on their own; I did describe all my feelings, just not that I thought I might be manic-depressive. I always thought that I was just being a hypochondriac. What do you think?


Dear Bipolar?,

When everything seems to be going wrong for you in one moment and completely fine in the next, it can be difficult to know what to do to get support. However, if you feel like you are riding a vicious rollercoaster of emotion to no avail, it may be helpful to try different behavioral strategies or bring in an expert perspective from a mental health care provider. There could be a myriad of reasons that you're fluctuating between emotions, so kudos to you for trying to figure it out. 

There could be a few options that fit how you're feeling, but only a mental health professional can provide a diagnosis. Bipolar disorder (also called manic depression), which you noted, varies from person to person; however, general trends involve two alternating periods of depression and mania. During depressive times, people often don't feel pleasure in anything, lack energy, and may be lethargic, lonely, and especially sensitive, sometimes to the point of tears over seemingly small things. Alternately, on the manic end, people may feel increased confidence, lack of inhibition, or the need for less sleep as a result of rapid thoughts. It should also be noted that manic depression isn’t the only kind of mood disorder. Many people who deal with major depression, premenstrual dysmorphic disorder (PMDD), substance-induced mood disorder, seasonal affective disorder (SAD), and dysthymia experience symptoms similar to those that appear during a depressive episode for someone with bipolar disorder. 

If you think that you may have a mood disorder, it can be a good idea to bring your concerns to a health care professional. You mention that you have seen mental health providers in the past, which can be a really great first step. It never hurts to get a second opinion and express some of these ebbs and flows in your feelings upfront. However, to better understand changes in your mood and how certain activities may influence how you're feeling, you may consider keeping a daily diary or mood chart. This could be a way to understand exactly when you’re experiencing different feelings. If you decide to reach out to a mental health professional, it can also serve as additional context for them in any conversation you're having. 

Depending on your symptoms, after starting the process with one mental health professional, you may be referred to another that specializes in psychiatric care. Typical treatments for mood disorders involve a combination of antidepressants and cognitive behavioral therapy (CBT). Selective serotonin reuptake inhibitors (SSRIs) are some of the most common antidepressants used to manage the symptoms of a mood disorder. CBT also focuses on the development of coping skills that may help you challenge unsettling thoughts and behaviors. There may also be some lifestyle factors to consider when thinking about treatment such as: 

  • Monitoring any alcohol and substance use. If you choose to use alcohol or other substances, keeping track of your intake could help you understand if these things might be triggering mood changes. 
  • Maintaining a balanced schedule. Are you allocating enough time for you to sleep, exercise, or practice mindfulness? If they aren't already part of your daily routine, you might try adding some of these activities in to see how it impacts your mood day to day. 
  • Focusing on establishing and maintaining healthy relationships. Removing or avoiding toxic relationships can help to minimize stress and anxiety that may be contributing to your changes in mood. Instead, you might try focusing on creating or maintaining healthy relationships with people who can support and encourage behaviors that don’t worsen your mood. 

List adapted from the Cleveland Clinic

Everyone defines and evaluates emotional changes and fluctuations for themselves differently. Seeking a professional's opinion and advice can help you distinguish between normal ups and downs or a condition that could be helped by therapy or medication. For more information about seeking a mental health professional, check out Types of therapists and How to find a therapist in the Go Ask Alice! Archives. 

Keep in mind that seeking out help from a mental health professional isn't just for those with depression—doing so can help you make heads and tails of many aspects of your life, no matter where you are at the present moment. 

Last updated Jun 16, 2023
Originally published Nov 01, 1993

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