Bipolar II disorder

Bipolar I disorder is a chronic mood disorder defined by at least one manic episode lasting a week or requiring hospitalization, with three or more DIG FAST symptoms causing marked impairment. Diagnosis is clinical after substances and medical mimics are excluded. Acute mania is treated with lithium or valproate, often with an atypical antipsychotic, and most patients need lifelong mood-stabilizer maintenance.

Cyclothymic disorder is a chronic bipolar-spectrum illness with numerous hypomanic-range and depressive-range periods that never meet full episode criteria for at least 2 years (1 year in children). Diagnosis is clinical; first-line treatment is cognitive behavioral therapy (CBT), with divalproex sodium started when functioning is impaired.

Borderline personality disorder is a cluster B personality disorder defined by 5 or more of 9 DSM-5 criteria spanning instability of relationships, self-image, and affect, marked impulsivity, and recurrent self-injury or suicidality; dialectical behavior therapy is the first-line treatment, with pharmacotherapy reserved as a secondary, symptom-targeted adjunct.

Major depressive disorder is a mood disorder defined by 5 or more of 9 major depressive episode symptoms, including depressed mood or anhedonia, present nearly every day for at least 2 weeks and causing significant functional impairment. Diagnosis is clinical, screened with the Patient Health Questionnaire. First-line treatment is cognitive behavioral therapy, a selective serotonin reuptake inhibitor (SSRI) such as sertraline, or both, escalating to augmentation, esketamine, or electroconvulsive therapy for refractory or acutely suicidal presentations.

Persistent depressive disorder (formerly dysthymia) is chronic, low-grade depressed mood present more days than not for at least 2 years with at least two associated symptoms and no symptom-free interval longer than 2 months. First-line treatment is long-term individual insight-oriented psychotherapy or cognitive behavioral therapy (CBT); a selective serotonin reuptake inhibitor (SSRI) such as sertraline is added when psychotherapy alone fails.

Premenstrual dysphoric disorder is a severe, cyclic mood disorder in which at least five of eleven affective and somatic symptoms recur during the luteal week of most menstrual cycles over 12 months and remit within about a week of menses onset. Diagnosis is clinical. First-line treatment is a selective serotonin reuptake inhibitor such as sertraline 50 mg or fluoxetine 20 mg daily, dosed continuously or only during the luteal phase.

Seasonal affective disorder is the 'with seasonal pattern' specifier applied to major depressive disorder or to bipolar 1 or 2 disorder, with episodes recurring in autumn or winter and remitting by spring for at least 2 consecutive years. Diagnosis is clinical, using standard mood-episode criteria plus the seasonal timing. First-line treatment is daily phototherapy, 10,000 lux for 30 to 60 minutes each morning, combined with a second-generation antidepressant such as bupropion XL.

Postpartum depression is a major depressive episode with onset during pregnancy or within 4 weeks of delivery (the DSM 'with peripartum onset' specifier), clinically recognized throughout the first 12 months after birth. Diagnosis requires five or more DSM depressive symptoms for at least 2 weeks with functional impairment; first-line treatment is cognitive behavioral therapy (CBT) or an SSRI such as sertraline, both compatible with breastfeeding.

Valproate/divalproex, lamotrigine, carbamazepine, oxcarbazepine, and second-generation antipsychotics are the mood stabilizers used for bipolar disorder when lithium is ineffective, poorly tolerated, or contraindicated. Valproate treats acute mania, mixed episodes, and rapid cycling with an oral loading dose; lamotrigine, titrated slowly to limit serious rash, treats bipolar depression and maintenance but not acute mania; carbamazepine is second-line, limited by agranulocytosis.