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Bipolar Disorder (Depressive Episode)MANAGEMENT

PSYCHIATRIC PRESENTATIONS · 12 SECTIONS

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825 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Acute anxiety Acute psychosis Agitation-behavioral emergency Anorexia Nervosa (Medical Complications)Bipolar disorder Bipolar Disorder (Depressive Episode)Bipolar Disorder (Manic Episode)Bulimia Nervosa (Medical Complications)Catatonia Conversion disorder Dementia and behavioral crisis Factitious Disorder Failure to Cope (Social)Failure to Thrive Generalized Anxiety Disorder Homicidal Ideation Major Depressive Disorder Major depressive episode Malingering Neuroleptic malignant syndrome Panic Attack Post-Traumatic Stress Disorder (Acute)Schizophrenia Exacerbation Suicidal Ideation Suicidal ideation and attempt Suicide Attempt

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp48

Immediate safety priorities

›Suicidality triage

›Active suicidal ideation with plan or intent

›Highest cause of premature mortality in bipolar disorder is death by suicide

›Immediate safe environment: remove access to lethal means

›Prior suicide attempt history

›Strongest predictor of future attempt

›Risk escalates with mixed features co-occurring

›Mixed features identification

›Co-occurring manic and depressive symptoms

›Markedly increased suicide risk compared to pure depressive episode

›Psychiatric emergency triggers

›Psychotic features

›Command auditory hallucinations

›Paranoid delusions with agitation risk

›Catatonia

›Immobility or mutism

›Waxy flexibility or posturing

›Severe functional decline

›Inability to eat or drink

›Inability to perform self-care

Monitoring and stabilization

›Risk stratification targets

›Columbia Suicide Severity Rating Scale (C-SSRS)

›Ideation intensity and plan specificity

›Intent and behavior subscale

›Agitation level monitoring

›Richmond Agitation Sedation Scale (RASS) for agitated presentations

02History/hx79

Presenting episode

›Current mood episode characterization

›Persistent sad or irritable mood

›Duration of current episode

›Time since last euthymic period

›Neurovegetative symptoms

›Anhedonia

›Hypersomnia or insomnia

›Hyperphagia or appetite loss

›Psychomotor changes

›Retardation: slowed speech and movement

›Agitation: restlessness or hand-wringing

›Cognitive symptoms

›Fatigue and loss of energy

›Poor concentration

›Worthlessness or inappropriate guilt

Bipolar-specific history

›Prior manic or hypomanic episodes

›Periods of elevated or expansive mood

›Decreased need for sleep

›Increased goal-directed activity or productivity

›Hypomanic symptoms missed by patient

›Collateral history from family often essential

›Grandiosity and increased talkativeness

›Antidepressant-induced mood destabilization

›New agitation or irritability after starting antidepressant

›Treatment-emergent mania or hypomania

›Episode history

03Physical Exam/exam69

Vitals and general appearance

›Vital signs

›Blood pressure

›Baseline for antipsychotic-related orthostatic hypotension monitoring

›Elevated BP may suggest anxiety or agitation component

›Heart rate

›Tachycardia with agitation or mixed features

›Bradycardia with psychomotor retardation

›Weight and BMI

›Baseline before initiating antipsychotics

›Weight gain with quetiapine, olanzapine, valproate

›General appearance

›Psychomotor retardation

›Slowed speech with long latency

›Slowed movement and soft voice

›Psychomotor agitation

›Hand-wringing, pacing, inability to sit still

›Associated with mixed features and higher suicide risk

›Self-care and hygiene

›Neglect indicating severity of functional impairment

›Disheveled appearance in severe or psychotic depression

Mental status exam

›Mood and affect

›Mood descriptor (patient's subjective report)

›Sad, empty, hopeless

›Irritable mood: common in bipolar depression and mixed features

›Affect quality

›Flat or blunted: suggests severity or medication effect

04Differential Diagnosis/ddx57

Mood disorders

›Psychiatric diagnoses

›Major depressive disorder (MDD)

›ICD-10 F32 or F33

›No history of mania or hypomania distinguishes MDD from BD

›Bipolar I disorder (depressive episode)

›ICD-10 F31.3 to F31.5

›At least one lifetime manic episode required

›Bipolar II disorder (depressive episode)

›ICD-10 F31.81

›Hypomanic episodes but no full mania

›Cyclothymic disorder

›ICD-10 F34.0

›Subsyndromal mood swings over >= 2 years

›Personality and anxiety disorders

›Borderline personality disorder

›ICD-10 F60.3

›Affective dysregulation is enduring and reactive to psychosocial triggers, not episodic

›Differentiating clue: interpersonal sensitivity and identity disturbance

›Persistent depressive disorder (dysthymia)

›ICD-10 F34.1

›Chronic low-grade depression > 2 years without manic episodes

Substance and medical mimics

›Substance-related

›Substance-induced mood disorder

›Cocaine and amphetamines can mimic mania

›Alcohol and cannabis worsen and mimic depressive episodes

›Symptoms should resolve after drug discontinuation

05Laboratory Tests/lt62

Baseline workup

›Standard initial labs

›Thyroid stimulating hormone (TSH)

›Rule out thyroid disease as mood disorder cause

›Baseline required before initiating lithium

›Repeat every 6-12 months on lithium

›Complete blood count (CBC)

›Baseline before valproate (thrombocytopenia risk)

›Monitor for lithium-induced leukocytosis

›Comprehensive metabolic panel

›Renal function: creatinine and GFR for lithium candidacy

›Hepatic function: LFTs baseline before valproate

›Electrolytes: sodium depletion increases lithium toxicity risk

›Metabolic and endocrine

›Fasting glucose

›Metabolic baseline before atypical antipsychotics

›Repeat at 3 months then annually

›Fasting lipid panel

›Baseline before antipsychotics (metabolic syndrome risk)

›Weight gain with olanzapine and quetiapine associated with dyslipidemia

›HbA1c

›Long-term glycemic status

›Elevated risk of diabetes with atypical antipsychotics

Medication monitoring labs

›Lithium monitoring

›Serum lithium level

›Target 0.6-0.8 mEq/L for bipolar depression

›Toxic level > 1.5 mEq/L; severe toxicity > 2.0 mEq/L

06Diagnostic Tests/dt67

Scoring Systems

›Bipolar depression severity and risk tools

›Columbia Suicide Severity Rating Scale (C-SSRS)

›Standardized ideation intensity and behavior assessment

›Widely validated across psychiatric settings

›Recommended by FDA and Joint Commission for suicide risk monitoring

›Hamilton Depression Rating Scale (HAM-D)

›17-item clinician-administered scale

›Score >= 20 indicates moderate-severe depression

›Used to track treatment response over time

›Montgomery-Asberg Depression Rating Scale (MADRS)

›10-item scale sensitive to antidepressant change

›Score >= 30 indicates severe depression

›Preferred in bipolar research trials

›Young Mania Rating Scale (YMRS)

›11-item clinician-administered mania severity tool

›Used to detect mixed features and manic rebound

›Score >= 8 suggests significant manic symptoms

›Bipolar screening tools

›Mood Disorder Questionnaire (MDQ)

›Self-report screening for bipolar spectrum

›Sensitivity ~73%, specificity ~90% for bipolar I

›Positive screen warrants full structured interview

›Hypomania Checklist-32 (HCL-32)

›32-item self-report for hypomanic symptoms

›Useful for detecting BD II in patients presenting as depressed

›Score >= 14 suggests hypomanic history

07Disposition/dispo50

Inpatient admission criteria

›Criteria for psychiatric hospitalization

›Suicidality with plan or intent

›Active suicidal ideation with specific plan and intent to act

›Recent high-lethality attempt

›Psychotic features

›Command hallucinations with inability to resist

›Severe paranoia preventing engagement with care

›Inability to care for self

›Not eating or drinking

›Gross functional impairment without support

›Mixed features with high agitation

›Safety risk to self or others

›Require monitoring for antidepressant discontinuation

›Voluntary vs involuntary admission

›Voluntary admission preferred when patient agrees

›Therapeutic alliance preservation

›Better engagement with inpatient treatment

›Involuntary commitment when imminent safety risk

›Jurisdiction-specific criteria apply

›Physician or designated health professional certification required

Discharge and outpatient criteria

›Criteria for safe discharge

›No active suicidal ideation with plan or intent

›Safety plan completed and documented

›Lethal means counseling completed

›Adequate social support and safe environment

›Responsible person accompanying patient

08Treatment/t147

Acute pharmacotherapy: FDA-approved agents

›Quetiapine

›Dosing for bipolar depression

›50 mg at bedtime on day 1

›Titrate to 300 mg/day by day 4

›Target 300-600 mg/day

›Side effects

›Sedation: particularly at lower doses

›Weight gain and metabolic effects

›QTc prolongation: baseline ECG recommended

›Evidence

›Approved for BD I and BD II depressive episodes

›First-line monotherapy per VA/DoD guidelines

›Lurasidone

›Dosing

›20-60 mg/day as monotherapy

›20-120 mg/day as adjunct to lithium or valproate

›Must be taken with food >= 350 kcal for adequate absorption

›Side effects

›Minimal weight gain compared to quetiapine

›Akathisia: monitor and manage

›No significant QTc prolongation

›Evidence

›Class I recommendation as monotherapy or adjunct

›Favorable metabolic profile

›Cariprazine

›Dosing

›1.5 mg/day starting dose

›Target 1.5-3 mg/day for bipolar depression

›Slower titration reduces akathisia risk

›Side effects

›Akathisia: most common adverse effect

›Minimal weight gain

›No significant metabolic effects

›Evidence

›FDA approved for bipolar I depressive episodes

›NNT ~7-8 for response vs placebo

›Lumateperone

›Dosing

›42 mg/day fixed dose

›No titration required

›Take at same time each day

›Side effects

›Favorable metabolic profile

›Somnolence and dizziness

›Minimal extrapyramidal effects

›Evidence

›Approved for BD I and BD II depressive episodes

›Effective as monotherapy and adjunct

›Olanzapine-fluoxetine combination (OFC)

›Dosing

›6 mg/25 mg starting dose

›Maximum 12 mg/50 mg

›Titrate based on response and tolerability

›Side effects

›Highest response rate ~57% vs placebo

›Significant weight gain >= 7% in ~30% of patients

›Metabolic monitoring essential

›Evidence

›FDA approved for BD I depressive episodes

›Highest NNH for weight gain among approved agents

Mood stabilizers

›Lithium

›Dosing for bipolar depression

›Starting dose 300 mg two to three times daily

›Target level 0.6-0.8 mEq/L for depressive episodes

›Titrate over 1-2 weeks based on level and tolerability

›Monitoring

›Level, renal function, and TSH at baseline then every 6-12 months

›Level check 5-7 days after dose change

›Maintain consistent sodium and fluid intake

›Anti-suicidal properties

›Reduces suicidality in bipolar disorder beyond mood stabilization

›Class I recommendation for suicide risk reduction

›Toxicity

›Early: tremor, nausea, diarrhea, polyuria

›Moderate: ataxia, confusion, slurred speech

›Severe: seizures, cardiac arrhythmia at levels > 2.0 mEq/L

›Lamotrigine

›Dosing (slow titration mandatory)

›Week 1-2: 25 mg/day

›Week 3-4: 50 mg/day

›Week 5: 100 mg/day

›Target maintenance 100-200 mg/day

›Rash risk management

›Stevens-Johnson syndrome risk 5-10%

›Counsel on immediate discontinuation with any rash

›Slower titration with valproate co-administration (halve dose)

›Clinical notes

›Effective for depressive relapse prevention

›Monotherapy may not be adequate for acute bipolar depression per VA/DoD

›Adjunct to lithium or quetiapine preferred for acute treatment

›Valproate

›Dosing

›500-750 mg/day divided doses starting

›Target level 50-100 mcg/mL (350-700 mmol/L)

›Extended release formulation for tolerability

›Monitoring

›Trough level, LFTs, CBC, weight

›Ammonia if mental status changes

›Absolute contraindication in pregnancy (FDA Category X-like teratogenicity)

›Evidence level

›Class IIa recommendation as adjunct for bipolar depression

›Less robust acute depression evidence than lithium

Cautions and contraindications

›Antidepressant monotherapy risks

›Treatment-emergent mania or hypomania

›Risk up to 12% in RCTs, up to 30% in retrospective studies

›Higher risk in BD I than BD II

›Rapid cycling induction

›Antidepressants can precipitate rapid cycling (>= 4 episodes/year)

›Avoid in patients with rapid cycling history

›Higher switch risk agents

›Tricyclic antidepressants: highest switch risk

›SNRIs: intermediate switch risk

›SSRIs and bupropion: lowest switch risk if used

›If antidepressant used

›Must combine with mood stabilizer or atypical antipsychotic

›Avoid in mixed features, rapid cycling, prior antidepressant-induced destabilization

Non-pharmacologic treatments

›Psychotherapy

›Cognitive behavioral therapy for bipolar (CBT-BP)

›Relapse prevention and coping skills

›Efficacy as adjunct to pharmacotherapy

›Interpersonal and Social Rhythm Therapy (IPSRT)

›Regularizes sleep-wake and social rhythms

›Reduces relapse rates as adjunct

›Psychoeducation

›Illness course and prodrome recognition

›Medication adherence and side effect management

›Electroconvulsive therapy (ECT)

›Indications

›Severe or psychotic bipolar depression unresponsive to pharmacotherapy

›Catatonia refractory to benzodiazepines

›Pregnancy where pharmacotherapy is high risk

›Efficacy

›Response rates 60-80% in treatment-resistant bipolar depression

›Rapid onset particularly useful in life-threatening presentations

›Contraindications

›No absolute contraindications

›Relative: elevated intracranial pressure, recent MI, unstable cardiac disease

›Lifestyle interventions

›Sleep hygiene

›Regular sleep-wake schedule reduces cycling

›Avoid night shift work if possible

›Substance avoidance

›Alcohol abstinence or reduction

›Cannabis avoidance: worsens mood swings

›Physical activity

›Aerobic exercise as adjunct reduces depressive symptoms

›Moderate intensity 30 minutes 3-5 days/week

09Special Populations/sp85

Pregnancy

›Pregnancy and bipolar depression

›Mood episode risk peripartum

›Bipolar disorder carries high risk of postpartum psychosis and depression

›Prophylactic mood stabilizer continuation often indicated

›Teratogenicity considerations

›Valproate: highest teratogenic risk, associated with neural tube defects (1-2%) and cognitive impairment

›Avoid valproate in pregnancy whenever possible

›Lithium: Ebstein anomaly risk (0.05-0.1%); much lower than previously reported

›Lamotrigine: relatively safer; monitor levels as clearance increases in pregnancy

›FDA-approved agents in pregnancy

›Quetiapine: limited data but used clinically; neonatal extrapyramidal effects

›Lurasidone: limited human data; animal studies reassuring

›Risk-benefit discussion mandatory with patient and obstetrics

›Management principles in pregnancy

›Multidisciplinary team

›Maternal-fetal medicine consultation

›Perinatal psychiatry involvement

›Monitoring frequency increased

›Lithium levels monthly then every 2 weeks near term

›Level rises postpartum as renal clearance decreases

›Folic acid supplementation

›4-5 mg/day with valproate if continuation unavoidable

›0.4-1 mg/day with lamotrigine

›Breastfeeding considerations

›Lithium: excreted in breast milk; generally avoided

›Quetiapine and lamotrigine: lower transfer to breast milk; individual decision

Geriatric

›Older adult considerations

›Altered presentation

›Cognitive symptoms may predominate over mood symptoms

›Pseudodementia: severe depression mimicking dementia

›Higher rates of psychotic features in older adults

›Medical comorbidity burden

›Cardiovascular disease 2x more common in bipolar disorder

›Diabetes and obesity common comorbidities

›Drug interactions with cardiac and metabolic medications

›Pharmacokinetic changes in aging

›Lithium dosing adjustments

›Reduced renal clearance requires lower doses

›Target level 0.4-0.6 mEq/L to minimize toxicity in elderly

›More frequent monitoring needed

›Antipsychotic caution

›Increased sensitivity to extrapyramidal effects

›Orthostatic hypotension risk with quetiapine

›FDA black box warning: antipsychotics increase mortality in elderly with dementia

›Valproate in elderly

›Thrombocytopenia and tremor more pronounced

›Monitor ammonia if cognitive changes occur

›Suicide risk in elderly

›Higher lethality of attempts in older adults

›More planned, less impulsive

›Higher rate of completion per attempt than younger adults

›Social isolation as risk amplifier

›Widowhood and living alone

›Limited social support network

Pediatrics

›Pediatric bipolar depression

›Presentation differences

›Irritability often more prominent than sadness

›Mixed features more common than in adults

›Rapid cycling more common in children and adolescents

›Diagnostic challenges

›ADHD and bipolar disorder frequently co-occur

›Trauma and conduct disorder can mimic bipolar features

›DSM-5 requires careful exclusion of MDD, ADHD, and DMDD

›Pharmacotherapy in youth

›FDA-approved agents in pediatric bipolar depression

›Quetiapine: approved for BD I depression in age >= 10 years

›Lurasidone: approved for BD I depression in age >= 10 years

›Olanzapine-fluoxetine: not approved in pediatric bipolar depression

›Lithium dosing in youth

›10-30 mg/kg/day divided 2-3 times daily

›Target level 0.6-1.0 mEq/L

›More frequent level monitoring due to variable clearance

›Weight gain monitoring

›Antipsychotic-related weight gain more pronounced in youth

›BMI and metabolic monitoring at baseline then monthly for 3 months

›Psychosocial treatment emphasis

›Family-focused therapy (FFT)

›Involves parents and family in psychoeducation

›Reduces relapse rates in pediatric bipolar

›School-based accommodations

›Individualized Education Plan (IEP) if functional impairment

›Reduced homework load during acute episodes

›Child protection screening

›Trauma history evaluation

›Safe home environment assessment

10Background/b88

Epidemiology

›Prevalence and demographics

›Global prevalence

›Bipolar I disorder affects ~1% of the global population

›Bipolar II disorder affects ~1.1% of the global population

›Bipolar spectrum including cyclothymia affects 2-5%

›Age of onset

›Mean age of onset 20-25 years

›Onset before age 25 in majority of patients

›Late onset (> 50 years) raises organic etiology concern

›Sex distribution

›Bipolar I: equal prevalence in men and women

›Bipolar II: slightly higher prevalence in women

›Rapid cycling more common in women

›Mortality and burden

›Premature mortality

›Life expectancy reduced by 10-20 years vs general population

›Suicide accounts for 15-20 times general population rate

›Cardiovascular disease: 2x risk

›Comorbidity burden

›Substance use disorders: ~56%

›Anxiety disorders: ~71%

›Personality disorders: ~36%

›ADHD: ~10-20%

›Misdiagnosis prevalence

›Average delay to correct diagnosis: 5-10 years

›Majority first diagnosed with unipolar depression

›7% or more of MDD patients may have unrecognized bipolar disorder

Pathophysiology

›Neurobiological mechanisms

›Monoamine dysregulation

›Serotonin, dopamine, and norepinephrine pathway abnormalities

›Dopaminergic hyperactivity in mania; hypoactivity in depression

›Glutamate and GABA imbalance

›Excitatory-inhibitory balance disruption

›Ketamine and lithium effects on glutamate signaling

›Neuroinflammation

›Elevated pro-inflammatory cytokines (IL-6, TNF-alpha) during mood episodes

›Inflammatory markers correlate with episode severity

›Structural and circuit abnormalities

›Prefrontal cortex hypoactivity

›Reduced executive function and impulse control

›Emotion regulation impairment

›Amygdala hyperreactivity

›Exaggerated emotional response to stimuli

›Persistent across mood states in bipolar

›White matter abnormalities

›Reduced white matter integrity on diffusion tensor imaging

›Disrupted fronto-limbic connectivity

›Genetic and environmental factors

›Heritability ~80% from twin studies

›First-degree relative risk ~10x population rate

›Polygenic architecture: hundreds of risk loci identified

›Environmental triggers

›Sleep disruption and circadian rhythm dysregulation

›Psychosocial stress and life events

›Childhood trauma as epigenetic modifier

Therapeutic Considerations

›Mood stabilizer mechanisms

›Lithium mechanism

›Inositol monophosphatase inhibition

›GSK-3 beta inhibition reducing neuronal apoptosis

›BDNF upregulation supporting neuroprotection

›Valproate mechanism

›Sodium channel stabilization

›GABA enhancement

›Histone deacetylase inhibition (epigenetic effects)

›Lamotrigine mechanism

›Voltage-gated sodium channel blockade

›Reduces glutamate release

›Primarily effective on depressive phase

›Antipsychotic mechanisms in bipolar depression

›Quetiapine

›D2 and 5-HT2A antagonism

›Histamine H1 blockade contributes to sedation and depression benefit

›Active metabolite norquetiapine inhibits norepinephrine reuptake

›Lurasidone

›D2 and 5-HT2A antagonism with 5-HT7 antagonism

›5-HT7 antagonism contributes to antidepressant effect

›High 5-HT1A partial agonism adds anxiolytic benefit

›Chronobiologic considerations

›Circadian rhythm disruption as core mechanism

›Social rhythm regularization as therapeutic target

›Sleep deprivation can precipitate mania

›Seasonal patterns

›Depressive episodes more common in winter in some patients

›Light therapy adjunct in seasonal pattern bipolar depression (with caution for switch risk)

›Rapid cycling treatment complexity

›Antidepressant avoidance

›Thyroid optimization may help

›Valproate or clozapine for refractory rapid cycling

11Patient Discharge Instructions/pdi48

copy discharge instructions

›Bipolar depression home care

›Take all medications exactly as prescribed

›Do not stop mood stabilizers or antipsychotics without speaking to your doctor

›Stopping lithium suddenly can trigger a manic episode

›Take lurasidone with a full meal (at least 350 calories) for it to work properly

›Absorption is significantly reduced without food

›Keep a regular sleep schedule

›Go to bed and wake at the same time each day

›Sleep disruption can trigger mood episodes

›Avoid alcohol and recreational drugs

›Alcohol worsens bipolar depression and can interact with medications

›Cannabis worsens mood cycling

›Safety planning

›Crisis line and resources

›988 Suicide and Crisis Lifeline: call or text 988 (Canada/US)

›Local emergency department if feeling unsafe

›Lethal means safety

›Remove or secure firearms at home

›Store all medications in a locked location

›Have a trusted person check in regularly

›Mood tracking

›Daily mood log or app to detect early warning signs

›Share mood records with your psychiatrist or family doctor

›Warning signs to return to emergency department

›Thoughts of suicide with a plan or intent to act

›Go to the nearest emergency department immediately

›Call 911 or have someone drive you

12References/r25

Guidelines and key sources

›Clinical guidelines

›VA/DoD Clinical Practice Guideline for Management of Bipolar Disorder (2023)

›First-line recommendations for bipolar depression pharmacotherapy

›Lurasidone and quetiapine as preferred agents

›Canadian Network for Mood and Anxiety Treatments (CANMAT) and ISBD 2018 Guidelines

›Evidence hierarchy for bipolar depression treatments

›Lithium anti-suicidal recommendation

›American Psychiatric Association Practice Guideline for Bipolar Disorder

›Comprehensive diagnostic and treatment framework

›Monitoring recommendations for mood stabilizers

›Key evidence sources

›Calabrese JR et al — quetiapine vs placebo in bipolar I and II depression

›Established quetiapine as FDA-approved first-line agent

›Loebel A et al — lurasidone in bipolar depression (PREVAIL program)

›Monotherapy and adjunctive efficacy confirmed

›Tohen M et al — olanzapine-fluoxetine combination in bipolar depression

›Highest response rate but significant metabolic burden

›Sachs GS et al — STEP-BD: antidepressant use in bipolar depression

›Antidepressants not superior to placebo when added to mood stabilizers

›Supported caution with antidepressant use in bipolar disorder

›Coding standards

›ICD-10 F31.3 to F31.5: Bipolar affective disorder, current episode depressed

›F31.31 mild, F31.32 moderate, F31.4 severe without psychosis, F31.5 severe with psychosis

›ICD-10 F31.81: Bipolar II disorder

›SNOMED CT concept: Bipolar affective disorder, current episode depression

Learn More: Bipolar Disorder (Depressive Episode)→

Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.