WOKE UP FINE. FLIPPED MOOD BY LUNCHTIME. BIPOLAR, DOC?

This is a question I hear fairly often in my office. Sometimes it comes with a slightly sheepish look, as though the person were admitting something embarrassing and already regretting having brought it up with their doctor. At other times, it comes with genuine fear.

People often ask it after going through a recent experience that brings several similar moments to mind. They started the morning in a good mood, full of energy, only to find themselves suddenly overcome by anger, irritability or even low spirits a little later, seemingly out of nowhere. Then, during a routine appointment, out comes the question:

“Am I bipolar?”

The situation itself may sound very familiar. You leave home in a great mood to go to the cinema with your boyfriend. But while he is still trying to park the car at the shopping centre, you realise that you have already become sulky and withdrawn, your face has hardened, and your replies have taken on that clipped, frosty tone he can detect without even having to look at you.

When you finally notice what has happened, you start wondering why. Did you secretly want to do something else? Was it simply a difficult week, with the exhaustion only catching up with you now that you have finally relaxed? Are you unconsciously reliving things from the past that have little or nothing to do with what is happening in the present?

Or then comes the diagnostic suspicion:

Could this be bipolar disorder?

Let us begin with a simple truth: a certain degree of emotional fluctuation, including some unpredictability as to when it will happen, is part of being human. Otherwise, we would be rather like robots, doing everything in the same tone and responding according to a fixed programme. Even the chatbots that now appear to display “emotional” reactions are, as far as we know, simply following the script.

Being in the world affects us. That is part of what being alive means. Projects excite us. Frustrations irritate us. Tiredness weighs us down. Break-ups hurt. Hormones fluctuate. Dreams kindle hope. And yes, even a frustrating trip around a shopping-centre car park can extinguish the good mood that left home entirely intact.

Much of the time, our mood is simply responding to what is happening around us. There is a technical expression for this: real life.

These fluctuations exist. They are normal — for those who are fond of the word “normal” — and they do not, by themselves, define a mental disorder. They are part of existence.

For that reason, it is worth discussing the matter calmly instead of immediately searching for a technical term to explain every change in mood. What lies behind these everyday fluctuations is usually far more varied — and far more common — than bipolar disorder.

That is not to say that bipolar disorder does not exist. It certainly does. It is simply good practice to consider the more ordinary possibilities first.

Do you see where I am going with this? :)

Very often, mood is responding to the surrounding environment. At that particular moment, you may be functioning like an emotional sponge: soaking up the overcrowded train, the unfriendly tone of the person who served you, the queue that refuses to move and that unnecessarily sharp message on WhatsApp.

It does not necessarily mean that your “internal thermostat” has broken. The outside world may simply be pushing it rather hard. And emotions do tend to lose some of their force once the situation has passed or once we have had a chance to regain our balance.

Some people also experience emotions very intensely and have relatively few resources for calming themselves once those emotions arrive in full force. This is not a moral failing. It is a way of functioning that can be understood and worked on.

In therapy, a person can learn to recognise the shift while it is happening — or perhaps even shortly before it happens — and develop a broader range of ways to respond without automatically acting in the heat of the moment.

At other times, it is not exactly the present that has changed. It is the past that has resurfaced.

An apparently innocent remark, a silence or a tone of voice resembling that of someone who hurt you before may trigger a reaction far more intense than the present situation seems to warrant. Without realising it, you have travelled back emotionally and begun reliving, in the present, something you felt in the past — something that once wounded you.

Some people, meanwhile, live in an almost permanent state of alert: an unstable job, a tense relationship, finances balanced on a knife edge and far too many sleepless nights. In those circumstances, mood fluctuates because life itself never seems to stop shifting.

It is hardly surprising that the body might respond to a succession of small fires with irritability, anxiety or sudden exhaustion.

Finally, there is the deeper dissatisfaction that can be much harder to name and that some people carry for months or even years: a meaningless job, a stagnant relationship or the feeling that they are living on autopilot.

When life as a whole feels out of place, a single grain of dust can look like an entire desert sandstorm. In such cases, the sudden irritability may not be the central problem. It may be a sign of something deeper that has not yet received the attention it deserves.

Thyroid dysfunction, the menstrual cycle, perimenopause, changes involving the adrenal glands or central nervous system, autoimmune illnesses, certain medications, substance use and sleep deprivation can also affect mood.

Each of these possibilities requires its own investigation. There is no need — and it would not be clinically sound — to leap straight to the conclusion that bipolar disorder must be responsible.

At the same time, common sense is needed. We should not dismiss everything as “just life,” either.

Episodes of rage, impulsivity or loss of control can have many different causes, and not all of them are as straightforward as becoming irritated on the way to the cinema.

Alongside the possibilities already mentioned, prolonged and severe stress, recurring interpersonal conflict, difficulty adjusting to a new situation, problems with emotional regulation, ADHD, anxiety, depressive disorders and certain personality patterns can all produce fluctuations that may initially resemble bipolar disorder but are not, in fact, bipolar disorder.

Psychiatry is, to a considerable extent, a field that requires — how shall I put it? — a kind of fine-tuning. It calls for patience, close attention to detail and precision.

This is precisely why self-diagnosis so often misses the mark. It may correctly identify a symptom, but it cannot easily weigh all the possible explanations with the necessary distance, method and clinical perspective.

When bipolar disorder is genuinely present, it is equally important to speak about it clearly. It is a serious condition, but it is treatable.

What usually distinguishes it from ordinary emotional fluctuations is not simply how quickly a person’s mood changes within a single day. In fact, when considered in isolation, that is rarely the central feature.

Bipolar disorder involves more sustained episodes, generally lasting for days or weeks, accompanied by noticeable changes not only in mood but also in energy levels, the need for sleep, the speed of speech and thought, self-esteem, activity levels and, in some cases, behaviour itself.

It is not simply a matter of feeling happy, productive or unusually enthusiastic on a Tuesday afternoon. There is a broader and more persistent change from the person’s usual way of functioning.

Without turning this informal conversation into a psychiatric treatise, bipolar disorder is estimated to affect somewhere between 0.5% and 1.5% of the population, with broadly similar rates reported in Brazil and elsewhere according to recent reviews.

In the DSM-5 classification, bipolar disorder is divided into bipolar I disorder, which involves episodes of full mania, and bipolar II disorder, which involves episodes of hypomania and depression.

First-line treatment usually involves mood-stabilising medication, often combined with psychotherapy. Treatment is generally approached as ongoing, long-term management rather than as a one-off cure.

As you may have gathered, bipolar disorder does not necessarily mean moving from happiness to sadness several times in a single day. Rather, apparently opposing symptoms tend to occur in episodes of meaningful duration over the course of a person’s life. In some cases, symptoms from opposite poles may even be present at the same time; these are known as episodes with mixed features.

The expression “rapid cycling,” despite what it may suggest in everyday language, does not mean changing mood every half an hour. In psychiatry, it refers to the occurrence of a specified number of distinct mood episodes within a year.

From the factor we call “life” to a mental disorder with well-established characteristics and diagnostic criteria, treatment is possible.

Sometimes clinicians even begin treating the symptoms before they have reached a firm conclusion about the exact name of the disorder. It may take time for a psychiatrist to settle on a diagnosis, but that does not mean they cannot intervene with medication and/or non-pharmacological measures in the meantime.

In fact, they should.

The main priority is to reduce psychological suffering and prevent symptoms from causing avoidable harm and disruption throughout a person’s life.

I would therefore like to emphasise this: if you suspect that something more than the ordinary fluctuations of life may be happening, seek a professional assessment.

The purpose is not to acquire a label. It is to understand what is actually happening — and also what is not happening.

Reaching that understanding requires clinical listening, a detailed personal history and, quite often, observation over time. No checklist of symptoms read in a hurry can replace that basic formula.

In the end, “Am I bipolar?” may not be the most important question.

A more useful question might be:

Am I living with balance, functioning reasonably well and taking care of my health?

When the answer is no, that alone is already a good enough reason to seek help — whether or not there is a single name that explains everything.

Image credit: AI-generated from a prompt written by the author.