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Relaxed in the morning, irritable at midday, sad for no reason in the evening: almost everyone knows mood swings. To some extent, they are part of life. They become distressing when they occur often, intensely or without a recognisable trigger and affect relationships, work or sleep. Behind marked swings there is often a treatable cause – the thyroid, the menstrual cycle or the menopause, but sometimes also depression or bipolar disorder. Here you will learn when mood swings are normal, when they should be assessed by a doctor – and where to get help immediately in a crisis.
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For suicidal thoughts or in an acute crisis, get help immediately: helpline 0800 111 0 111 or 0800 111 0 222 – free, around the clock.
Mood swings are frequent, often rapid changes in emotional state. Within hours or days, mood shifts between positive feelings such as joy and balance and negative feelings such as irritability, sadness, anger or inner restlessness. To some extent, such shifts are completely normal and part of human experience.
Mood swings become problematic when they occur often, intensely or without a recognisable trigger and noticeably affect life – relationships, work, sleep or your own wellbeing. There is then often a medical, hormonal or psychological cause behind them that should be investigated.
Thyroid: An overactive thyroid causes irritability, inner restlessness and nervousness; an underactive thyroid tends to cause low mood and lack of drive. Both are easily treatable – a TSH value clarifies this quickly.
Menstrual cycle and PMS: Three to eight days before menstruation, many women report low mood, irritability or anxiety. With marked symptoms, this is referred to as premenstrual dysphoric disorder (PMDD) – well treatable.
Menopause: The drop in oestrogen can trigger mood swings, sleep problems and depressive symptoms. Hot flushes and night-time sleep loss intensify the symptoms.
Pregnancy and the postnatal period: Hormonal changes shift mood in both directions. Postnatal depression should be recognised and treated promptly.
In men – testosterone: Testosterone deficiency in middle to older age can manifest as irritability, lack of drive and mood swings – in men often hidden behind 'fatigue' or 'stress'.
Hyperthyroidism and underactive thyroid, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), the menopause, pregnancy and the postnatal period, testosterone deficiency.
Depression: Low mood over a longer period, lack of drive, loss of interest, sleep problems, self-blame.
Bipolar disorder: Alternation between depressive and manic/hypomanic phases (elevated drive, reduced need for sleep, increased activity, risky behaviour).
Cyclothymia: 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 marked mood swings.
Lack of sleep, stress, being over- or under-challenged, lonely periods of life, acute stresses (separation, bereavement, job loss), vitamin D deficiency in winter, substance use (alcohol, cannabis, drugs).
Corticosteroids, beta-blockers, thyroid medications, hormonal contraceptives, antidepressants (particularly at the start), sleeping tablets, some painkillers.
Vitamin D or B12 deficiency, chronic illnesses (diabetes, heart failure), neurological conditions (Parkinson's, multiple sclerosis, dementia), chronic pain.
Mood changes are not automatically pathological – everyone has them. The transition from 'normal' to 'needing assessment' shows in a few features:
| Feature | Normal swings | Pathological swings |
|---|---|---|
| Trigger | Recognisable (stress, sleep, conflict) | Often without 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 changes, identity formation, social pressure and shifts in sleep all coincide. Attention is needed, however, if persistent low mood, social withdrawal, dropping performance at school, self-harm or suicidal thoughts develop. Where to go: paediatric practice, school psychology services or the youth helpline (Nummer gegen Kummer): 116 111.
Hyperthyroidism → antithyroid medication; underactive thyroid → levothyroxine. For PMS/PMDD: lifestyle adjustments, possibly an SSRI in the luteal phase, in some cases hormonal contraception. For menopausal symptoms: hormone replacement therapy after individual assessment of risks and benefits. For testosterone deficiency in men: replacement after a confirmed diagnosis.
Psychotherapy (cognitive behavioural therapy, psychodynamic therapy) is first-line treatment for depression, anxiety disorders and personality disorders. For moderate to severe episodes, combination with medication (SSRIs, SNRIs, mood stabilisers for bipolar disorder such as lithium, valproate, lamotrigine). Important: the diagnosis of bipolar disorder must be clarified before antidepressant therapy – antidepressants without a mood stabiliser can trigger manic phases in people with bipolar disorder.
A regular sleep–wake rhythm, exercise outdoors, balanced nutrition, maintaining social contacts, reducing alcohol and caffeine. A mood diary via apps or notebooks helps to identify triggers and document treatment progress. For mild low mood, St John's wort, lavender, passionflower or valerian can provide support – note: St John's wort has many interactions (e.g. with the contraceptive pill and blood thinners), so ask a doctor before taking it.
Some medications can change mood – others are the most important treatment option. An overview:
| Medication | Effect on mood |
|---|---|
| Corticosteroids (systemic) | Can cause irritability, sleep problems, euphoria or depressive symptoms – particularly at higher doses |
| Hormonal contraceptives | Can worsen low mood in some women – switching the preparation can help |
| SSRIs / SNRIs (antidepressants) | First-line treatment for depression – effect after 2–6 weeks, possibly some restlessness initially |
| Mood stabilisers (lithium, valproate, lamotrigine) | Core treatment for bipolar disorder – regular blood level checks needed |
Beta-blockers, thyroid medications (when over- or underdosed), sleeping tablets and some painkillers can also affect mood. If mood swings coincide with starting a new medication, this should be discussed with a doctor.
Digital medication plan: Record all medicines – GP, psychiatry, endocrinology and gynaecology can immediately see which agents may affect your mood. → Create a medication plan
Interaction checker: Which medications can change your mood? → Start the interaction checker
Medication reminder: Take antidepressants, mood stabilisers and thyroid medications regularly. → Set up reminder
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