Bipolar I, II, and Cyclothymia

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


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