Mood Disorders
Depression and mania
Know the DSM-5-TR criteria for a major depressive episode (≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia) and a manic episode (≥1 week of elevated/irritable mood plus ≥3 of grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, risky behaviour; ≥4 days for hypomania without marked impairment or psychosis).
Distinguish bipolar I (mania), bipolar II (hypomania plus depression, no mania), and cyclothymia. Understand mixed features, rapid cycling (≥4 episodes/year), and peripartum and seasonal specifiers.
Management principles
Unipolar depression: psychological therapy for mild-moderate, antidepressant for moderate-severe, ECT for severe/psychotic/refractory or life-threatening. Bipolar: mood stabiliser first (lithium, valproate, lamotrigine), and never antidepressant monotherapy in bipolar I due to switch risk. Lithium remains the gold standard for maintenance and suicide prevention; know its toxicity (tremor, ataxia, vomiting, renal and thyroid effects) and monitoring.
Traps
- Treating bipolar depression with antidepressant monotherapy.
- Missing that mania is a medical emergency requiring urgent control.
- Forgetting the 2-week minimum for a depressive episode and that bereavement no longer excludes diagnosis.
Rule of thumb
Any patient with recurrent depression should be screened for prior hypomania before starting an antidepressant - the missed bipolar question.