First thing’s first, it is important to understand the difference between a mood episode and a mood disorder.

Mood Episodes

The best way is to think of the episodes as the building blocks of the disorders.

Major Depressive Episode: 2 week period of depressed mood OR anhedonia plus 4 other symptoms of MSIGECAPS (useful mnemonic)

• Mood (low)
• Sleep (decreased)
• Interest (decreased)
• Guilt
• Energy (low)
• Concentration (poor)
• Appetite (decreased)
• Psychomotor retardation or agitation
• Suicidal ideation

Manic Episode: 1 week period of elevated or irritable mood with 4 or more of (mnemonic  GST PAID)

• Grandiose thoughts
• Sleep, decreased need for
• Talkative
• Pleasurable activities with Painful consequences (gambling, spending lots of money, having lots of sex)
• Activity increased
• Ideas (flight of)
• Distractability

Hypomanic Episode: Same as manic except dialled down a notch. Only needs to be 4 days with 3 or more symptoms. People can still function and generally like being hypomanic, but their friends and family will notice a difference in them.

Mixed Episode: BOTH manic episode and major depressive episode at the same time (as in during the same day they’ll experience both depression and mania) in 1 week.

Mood Disorders

Bipolar I

• 1 manic episode OR 1 mixed episode
• Treatment: mood stabilizer (lithium or anti-convulsant), consider adding atypical antipsychotic (quetiapine, clozapine, olanzapine)
• Carbamazepine, valproic acid, and lamotrigine do not have good antidepressant effects, they’re only antimanic
• Tegretol (carbamazepine) not used much because rush of Steven-Johnson’s syndrome, CP450 interactions and neutropenia

Bipolar II

• MDE + hypomanic episode
• NO manic or mixed episodes
• Treatment: lithium, consider adding atypical antipsychotic

Cyclothymia

• >2 years, never without symptoms for >2 months.
• Hypomanic + Depressive Symptoms (not meeting the criteria for MDE)
• Treatment: lithium, anticonvulsants (divalproex, lamotrigine)