1. What you can do now
First steps with mood swings
- Keep a mood diary: over 2–3 weeks, document mood, sleep, cycle and triggers – this helps to recognise patterns.
- Have hormonal causes checked: thyroid (TSH), cycle connection – common and treatable causes.
- Stabilise sleep: regular times, a screen break before going to bed. Lack of sleep considerably intensifies swings.
- Exercise and daylight: regular exercise and daylight have a measurable mood-stabilising effect.
- Check medications: cortisone, beta blockers, hormonal contraception can influence mood – discuss with your practice.
EMERGENCY: get help immediately
With suicidal thoughts, thoughts of self-harm or hopelessness – contact one of the following points of contact immediately:
Telefonseelsorge (German crisis line): 0800 111 0 111 or 0800 111 0 222 (free, around the clock). In the US: call or text 988 (Suicide & Crisis Lifeline).
On-call medical service (in Germany): 116 117 (also at night and at the weekend).
In acute danger to life: emergency number 112 (in the US: 911) or the nearest emergency department.
Also with phases of excessive drive, grandiose ideas and a clearly reduced need for sleep (suspicion of mania / bipolar disorder), seek medical help promptly.
2. Understanding mood swings – what happens in the body?
Mood swings describe a frequent, often rapid change in emotional state. Within hours or days, the mood switches between positive feelings like joy and balance and negative feelings like irritability, sadness, anger or inner restlessness. To a certain degree, such changes are completely normal and part of human experience.
Mood swings become problematic when they occur frequently, intensely or without a recognisable trigger and noticeably affect life – relationships, work, sleep or one's own wellbeing. Then there is often a medical, hormonal or psychological cause behind it that should be investigated.
Hormonal swings are the most common trigger
Thyroid: an overactive thyroid causes irritability, inner restlessness and nervousness, an underactive one rather a low mood and a lack of drive. Both can be treated well – a TSH value clarifies it quickly.
Cycle and PMS: 3–8 days before menstruation, many women report low moods, irritability or anxiousness. With strongly pronounced symptoms it is called premenstrual dysphoric disorder (PMDD) – treatable.
Menopause: the drop in oestrogen can trigger mood swings, sleep problems and depressive moods. Hot flushes and night-time lack of sleep intensify the symptoms.
Pregnancy and the postnatal period: hormonal changes alter the mood in both directions. Postnatal depression should be recognised and treated in time.
In men – testosterone: a testosterone deficiency in middle to older age can show itself as irritability, a lack of drive and mood swings – in men often hidden behind "tiredness" or "stress".
Important: mood swings in men look different
Instead of sadness, in men irritability, aggressiveness, social withdrawal or increased alcohol consumption often dominate. This "male depression" is frequently overlooked. If you as a man or as a relative notice such changes – a medical assessment is sensible, even if the word "depression" does not seem fitting at first.
3. Common causes of mood swings
3.1 Hormonal
Overactive thyroid and underactive thyroid, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), menopause, pregnancy and the postnatal period, testosterone deficiency.
3.2 Psychological
Depression: a low mood over a longer period, a lack of drive, loss of interest, sleep problems, self-reproach.
Bipolar disorder: a change between depressive and manic/hypomanic phases (elevated drive, reduced need for sleep, increased activity, risky behaviour).
Cyclothymia: a persistently unstable mood with numerous mild depressive and hypomanic phases.
Borderline personality disorder: rapid, intense mood changes, often as a reaction to relationship events.
Anxiety disorders and adjustment disorders: can be accompanied by pronounced mood swings.
3.3 Lifestyle and environment
Lack of sleep, stress, being over- or under-challenged, lonely phases of life, acute strains (separation, bereavement, job loss), vitamin D deficiency in winter, substance use (alcohol, cannabis, drugs).
3.4 Medications
Cortisone, beta blockers, thyroid preparations, hormonal contraception, antidepressants (especially at the start), sleeping pills, some painkillers.
3.5 Physical illnesses
Vitamin D or B12 deficiency, chronic illnesses (diabetes, heart failure), neurological illnesses (Parkinson's, multiple sclerosis, dementia), chronic pain.
4. Normal or abnormal?
Mood changes are not automatically abnormal – everyone has them. The transition from "normal" to "needs investigation" shows itself in a few features:
| Feature | Normal swings | Abnormal swings |
|---|
| Trigger | Recognisable (stress, sleep, conflict) | Often without a recognisable trigger |
| Intensity | Proportionate to the situation | Disproportionate or overwhelming |
| Duration | Hours to a few days | Weeks to months |
| Everyday life | Remains functional | Work, relationships, sleep are affected |
| Accompanying symptoms | None | Sleep problems, loss of energy, suicidal thoughts, physical symptoms |
Also important: in adolescents, mood swings during puberty are largely normal – hormonal change, finding an identity, social pressure and shifts in sleep come together. Attention is warranted, however, when persistent dejection, social withdrawal, a drop in school performance, self-harm or suicidal thoughts are added. Point of contact: the paediatric practice, school psychology services or the Nummer gegen Kummer (German youth helpline): 116 111.
5. What really helps
For hormonal causes
Overactive thyroid → antithyroid drugs; underactive thyroid → levothyroxine. For PMS/PMDD: lifestyle adjustment, if needed an SSRI in the luteal phase, in some cases hormonal contraception. For menopausal symptoms: hormone replacement therapy after an individual assessment. For testosterone deficiency in men: substitution after a confirmed diagnosis.
For psychological causes
Psychotherapy (cognitive behavioural therapy, psychodynamic therapy) is the first-line therapy for depression, anxiety disorder and personality disorders. For moderate to severe episodes, a combination with drug therapy (SSRIs, SNRIs, mood stabilizers for bipolar disorder such as lithium, valproate, lamotrigine). Important: the diagnosis of bipolar disorder must be clarified before antidepressant therapy – antidepressants without a mood stabilizer can trigger manic phases in bipolar patients.
Self-help and everyday life
A regular sleep-wake rhythm, exercise in the fresh air, a balanced diet, maintaining social contacts, reducing alcohol and caffeine. A mood diary via apps or notebooks helps to recognise triggers and to document treatment success. With mild low moods, St John's wort, lavender, passionflower or valerian can have a supporting effect – caution: St John's wort has numerous interactions (e.g. with the pill and blood thinners), get medical advice before taking it.
With suicidal thoughts or an acute crisis, get help immediately: Telefonseelsorge (German crisis line) 0800 111 0 111 or 0800 111 0 222 – free, around the clock. In the US: call or text 988 (Suicide & Crisis Lifeline).
