Which mood episodes are compared?

The table compares major depressive episodes, manic episodes, hypomanic episodes and presentations with mixed features.

Which differences are highlighted?

The table summarizes mood, energy, duration, severity, functional impairment and the relationship with the main mood disorders.

Why is it important to distinguish mania from hypomania?

The distinction helps differentiate bipolar I disorder from bipolar II disorder and guides clinical management.

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Summary table of mood episodes

Article written and reviewed by Dr Luca Moretti

Episode	Description	Minimum duration	Main features	Distinguishing notes
Major depressive episode	Syndrome characterized by depressed mood and/or marked loss of interest or pleasure, associated with other cognitive, neurovegetative or psychomotor symptoms and clinically significant distress or functional impairment.	At least 2 weeks in DSM 5 TR and ICD 11.	Depressed mood, anhedonia, changes in sleep, appetite or weight, reduced energy, psychomotor changes, guilt or worthlessness, cognitive difficulties, and thoughts of death or suicide.	By itself, it does not establish major depressive disorder: it can occur in both depressive disorders and bipolar disorders.
Manic episode	A distinct period of abnormally elevated, expansive or irritable mood associated with a marked increase in activity or energy and severe impairment of functioning.	DSM 5 TR: at least 1 week, or any duration if hospitalization is necessary. ICD 11: generally at least 1 week, unless shortened by treatment.	Grandiosity, decreased need for sleep, increased talkativeness, flight of ideas, distractibility, increased goal directed activity and impulsive or risky behaviors.	It causes marked functional impairment, may require intensive treatment and may include psychosis. A primary manic episode is the defining element of bipolar I disorder.
Hypomanic episode	A distinct period of altered mood and increased activity or energy, clearly different from usual functioning but without the severity characteristic of mania.	DSM 5 TR: at least 4 consecutive days. ICD 11: at least several days.	Elevated, expansive or irritable mood, increased energy, decreased need for sleep, increased talkativeness, accelerated thinking, distractibility and increased activity.	It does not cause marked impairment, does not require hospitalization because of episode severity and does not involve psychosis. It can occur in both bipolar II disorder and during the course of bipolar I disorder.
Mixed episode and mixed features	Presentation characterized by the coexistence of manifestations belonging to depressive and manic polarities, classified differently by DSM 5 TR and ICD 11.	DSM 5 TR: duration of the underlying episode. ICD 11: generally at least 2 weeks in the first presentation.	DSM 5 TR requires at least three qualifying symptoms of the opposite polarity. In ICD 11, several prominent manic and depressive symptoms may occur simultaneously or alternate rapidly.	The DSM 5 TR does not recognize a standalone mixed episode, but uses the specifier “with mixed features.” ICD 11 instead retains mixed episode as a distinct category.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing; 2022. doi:10.1176/appi.books.9780890425787.
World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. World Health Organization; 2024.
Yatham LN, Kennedy SH, Parikh SV, et al. CANMAT and ISBD 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170. doi:10.1111/bdi.12609. PMID:29536616.
Yatham LN, Chakrabarty T, Bond DJ, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations. Bipolar Disord. 2021;23(8):767-788. doi:10.1111/bdi.13135. PMID:34599629.
McIntyre RS, Berk M, Brietzke E, et al. Bipolar disorders. Lancet. 2020;396(10265):1841-1856. doi:10.1016/S0140-6736(20)31544-0. PMID:33278937.

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