Mood Disorders
Depression and bipolar disorders are real medical conditions, and they are treatable.
This information is educational and is not a diagnosis. Diagnosis requires a comprehensive psychiatric evaluation.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911.
What it is
Mood disorders affect how you feel, think, sleep and function. They go beyond ordinary sadness or a bad week. Depressive disorders involve periods of low mood or loss of interest. Bipolar disorders involve episodes of unusually elevated or irritable mood and energy (mania or hypomania), usually alternating with periods of depression.
Getting the diagnosis right matters, because depression and bipolar disorder are treated differently. A careful evaluation looks at your whole history, not just how you feel today.
Diagnostic features (DSM-5-TR)
A plain-language summary of key features described in the DSM-5-TR. This is not the official criteria text and is not a self-diagnosis tool.
Major Depressive Disorder
- For at least 2 weeks, depressed mood or loss of interest or pleasure, most of the day, nearly every day.
- Together with other symptoms, for a total of at least five, such as changes in appetite or weight, sleeping too little or too much, slowed or restless movement others can notice, fatigue, feelings of worthlessness or excessive guilt, trouble concentrating or deciding, and recurrent thoughts of death or suicide.
- Symptoms cause significant distress or difficulty functioning and are not due to a substance or medical condition. There has never been a manic or hypomanic episode.
Persistent Depressive Disorder
- Depressed mood for most of the day, more days than not, for at least 2 years (at least 1 year in children and teens, where mood may be irritable).
- At least two additional symptoms, such as appetite changes, sleep changes, low energy, low self-esteem, poor concentration or hopelessness.
- Symptoms have not been absent for more than 2 months at a time during that period.
Bipolar I Disorder
- At least one manic episode: a distinct period of abnormally elevated, expansive or irritable mood with increased energy or activity, lasting at least 1 week (or any length if hospitalization is needed).
- Accompanied by symptoms such as inflated self-esteem, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased goal-directed activity and risky behavior.
- The episode causes marked impairment, requires hospitalization, or includes psychotic features. Depressive episodes are common but not required for the diagnosis.
Bipolar II Disorder
- At least one hypomanic episode (similar symptoms lasting at least 4 consecutive days, noticeable to others but not severe enough to cause marked impairment or hospitalization).
- At least one major depressive episode.
- There has never been a full manic episode.
Common signs
- Persistent sadness, emptiness or hopelessness
- Loss of interest in things you used to enjoy
- Changes in sleep or appetite
- Low energy or fatigue
- Difficulty concentrating or making decisions
- Feelings of worthlessness or guilt
- Periods of unusually high energy with little need for sleep
- Racing thoughts or rapid speech
- Impulsive or risky decisions during high-energy periods
How it's evaluated
I will take a detailed history of your mood over time, including any past periods of unusually high energy, decreased need for sleep or impulsive behavior. Screening for bipolar disorder is essential before choosing a treatment.
Rating scales such as the PHQ-9 help measure symptoms and track progress. I also review physical health, medications, substance use and family history, and may recommend lab work, such as thyroid testing, to rule out medical contributors. Safety is always part of the conversation.
Evidence-based treatment options
Antidepressant medication
For depressive disorders, antidepressants such as SSRIs, SNRIs and other classes are effective options, chosen based on your symptoms, history and preferences.
Psychotherapy
Evidence-based therapies such as cognitive behavioral therapy (CBT) and interpersonal therapy are effective for depression, alone or combined with medication.
Mood stabilizers and antipsychotics for bipolar disorder
Lithium, certain anticonvulsants (such as valproate and lamotrigine) and some second-generation antipsychotics are used to treat mood episodes and prevent relapse. Antidepressants alone are generally avoided in bipolar I disorder.
Options for treatment-resistant depression
When first treatments do not help enough, options include adjusting or combining medications, esketamine nasal spray (FDA-approved for treatment-resistant depression), transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT).
How I can help
I start by understanding your full story, because the same symptoms can come from different causes. Distinguishing depression from bipolar disorder is one of the most important steps I take, since it guides which treatments are safe and effective for you.
Together we build a plan that may include medication, psychotherapy referrals and attention to sleep, nutrition and daily rhythm. I follow up closely, monitor response and side effects, and adjust the plan until you are feeling and functioning better.
Insight
Regular sleep and daily routines are more than self-care. For many people with mood disorders, protecting sleep is one of the most effective ways to help prevent new episodes.
Sources
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
- National Institute of Mental Health (NIMH): Depression
- National Institute of Mental Health (NIMH): Bipolar Disorder
- American Psychiatric Association: Clinical Practice Guidelines
- NICE guideline NG222: Depression in adults
- NICE guideline CG185: Bipolar disorder: assessment and management
Heal • Grow • Thrive
Ready When You Are.
Putting your mental health first is a strength. It is okay to ask for help.