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Summary Table of Mood Episodes

Episode Description Minimum Duration Main Features Distinctive Notes
Major Depressive Episode Phase marked by deeply depressed mood and significant functional impairment. At least 2 consecutive weeks Depressed mood, anhedonia, sleep and appetite changes, fatigue, guilt, suicidal ideation. May occur in major depressive disorder or bipolar disorders.
Manic Episode Pathological expansion of mood with increased energy, ideation, and reactivity. At least 1 week (or shorter if hospitalization is required) Euphoria, pressured speech, decreased need for sleep, grandiosity, impulsivity, risky behavior. Key feature of bipolar I disorder; often requires urgent intervention.
Hypomanic Episode Milder form of mania with similar but less severe and impairing symptoms. At least 4 consecutive days Elevated or irritable mood, increased activity, talkativeness, heightened energy without marked impairment. Characteristic of bipolar II disorder; often initially unrecognized.
Mixed Episode Simultaneous or rapidly alternating depressive and manic/hypomanic symptoms. Variable (DSM-5: at least 3 symptoms from the opposite pole) Irritability, agitation, unstable mood, fatigue with motor energy, suicidal ideation + impulsivity. High suicide risk; challenging to treat; common in young adults.
    References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Publishing. 2013.
  2. Belmaker RH et al. Major depressive disorder. N Engl J Med. 358(1), 2008: 55–68.
  3. Goodwin FK et al. Manic-depressive illness: bipolar disorders and recurrent depression. Oxford University Press. 2007.
  4. Grande I et al. Bipolar disorder. Lancet. 387(10027), 2016: 1561–1572.
  5. Vieta E et al. Mixed states in DSM-5: implications for clinical practice. Curr Med Res Opin. 30(4), 2014: 669–678.
  6. Merikangas KR et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry. 64(5), 2007: 543–552.
  7. McIntyre RS et al. The clinical characteristics of bipolar disorder: implications for diagnosis and management. CNS Spectr. 12(11), 2007: 3–10.
  8. Akiskal HS. The bipolar spectrum: new concepts in classification and diagnosis. J Clin Psychiatry. 58(Suppl 6), 1997: 6–11.