Mood disorders (depression and bipolar disorder)
Diagnosing major depression and bipolar disorder in medical patients, antidepressant choice and treatment-resistant options including PBS esketamine, and lithium, valproate and the other mood stabilisers with their monitoring and toxicity.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Mood disorders affected about 7.5% of Australians aged 16 to 85 in the past 12 months (ABS 2020 to 2022), and depression is about twice as common in women. In medical wards it is common after MI, stroke and with cancer and chronic pain, and it worsens outcomes in all of them.
- Always screen for bipolarity (past hypomania or mania, family history) before starting an antidepressant.
- Mild depression: psychological therapy or medication. Moderate to severe: antidepressant plus psychological therapy. Psychotic depression: antidepressant plus antipsychotic, or ECT.
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Sources
- The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disordersAU/NZRANZCP (Australian and New Zealand Journal of Psychiatry 2021;55:7-117), 2020 (published January 2021; over 5 years old, so check whether RANZCP still lists it as current)
- Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 update on clinical guidelines for management of major depressive disorder in adultsCANMAT (Canadian Journal of Psychiatry 2024;69:641-87), 2023
- Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorderCANMAT and ISBD (Bipolar Disorders 2018;20:97-170), 2018
- Depression in adults: treatment and management (NG222)National Institute for Health and Care Excellence, 2022
- Esketamine (Spravato) nasal spray PBS listing for treatment-resistant depressionAU/NZPharmaceutical Benefits Scheme (reported by Medicine Today), 2025
- Change to classification of psilocybin and MDMA to enable prescribing by authorised psychiatristsAU/NZTherapeutic Goods Administration, 2023
- Mental Health Care in the Perinatal Period: Australian Clinical Practice GuidelineAU/NZCentre of Perinatal Excellence (COPE), NHMRC approved, 2023
- Decker BS et al. Extracorporeal treatment for lithium poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin J Am Soc Nephrol 2015;10:875-87EXTRIP workgroup, 2015
- Assessing Fitness to Drive: psychiatric conditionsAU/NZAustroads and National Transport Commission, 2022
- National Study of Mental Health and Wellbeing 2020-2022AU/NZAustralian Bureau of Statistics, 2023
- Last updated
- 14 November 2026
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