A 45-year-old woman presents with persistent sadness, anhedonia, weight gain, hypersomnia, psychomotor retardation, and significant fatigue for 8 weeks. She denies suicidal ideation. She previously had a 4-day episode of elevated mood, decreased sleep, and increased productivity which she described as 'feeling great.' According to DSM-5, what is the MOST likely diagnosis?

• A Bipolar I disorder
• B Bipolar II disorder ✓
• C Major depressive disorder with atypical features
• D Cyclothymic disorder

Explanation

Bipolar II disorder requires at least one major depressive episode and at least one hypomanic episode (elevated/irritable mood for at least 4 consecutive days, not requiring hospitalization, no psychotic features, and causing change in function but not severe impairment). This patient's prior 4-day episode of elevated mood with decreased sleep and increased productivity fits hypomania. Bipolar I requires a full manic episode lasting at least 7 days. The current presentation is a major depressive episode within bipolar II.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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