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What Is An Episode?


Updated July 06, 2009

Question: What Is An Episode?
Wherever you see something written about bipolar disorder, you will encounter mentions of bipolar disorder episodes. Manic episodes, depressive episodes, mixed episodes - all are bipolar disorder episodes. But just what is an episode in the context of bipolar disorder?
Dictionary definitions of episode abound, but the nearest lay definition that fits a bipolar disorder episode is "an incident or event that is part of a larger sequence." The larger sequence, of course, is the ongoing flow between the highs and lows of manic depression.

The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) has strict durations for each type of episode that may occur in bipolar disorder:
  • A manic episode must last at least one week unless hospitalization is necessary - then the episode may be shorter and still be classed as manic.
  • A hypomanic episode must last at least four days.
  • A major depressive episode must last at least two weeks.
  • A mixed episode must last at least one week with symptoms present "nearly every day."
Within each of these time periods, a given number of certain diagnostic symptoms must appear. For example:
  • In a manic episode, there must be a sustained and abnormally elevated, expansive or irritable mood throughout the period.
  • In a hypomanic episode, there must be a sustained and elevated, expansive or irritable mood throughout the period - but the word "abnormally" is omitted from the description.
  • In a major depressive episode, at least one of the symptoms must be depressed mood or loss of pleasure or interest.
  • In a mixed episode, the criteria for both a major depressive episode and a manic episode must be met.
Thus, in terms of bipolar disorder, an episode is a distinct period of time when specific symptoms are present that, taken together, classify a person's mood as manic, hypomanic, depressive, or mixed.

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