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Mood Disorders

Depression, bipolar spectrum, treatment resistance, and the diagnostic nuances that separate them.

13 cases

advanced~30 min

Bipolar II — Maintenance Phase Decisions

A 42-year-old school psychologist with bipolar II disorder, stable for 18 months on lamotrigine and quetiapine, requests medication simplification due to weight gain, morning grogginess, and emerging metabolic concerns. The clinician must weigh the legitimate burden of long-term side effects against the risk of destabilizing a patient who is doing well — navigating a clinical space where guidelines offer little guidance and the art of psychiatry matters most.

Bipolar IIMaintenance TreatmentLamotrigine
intermediate~30 min

Depression After Medical Illness

A 58-year-old retired firefighter presents 6 weeks after an anterior wall STEMI with apathy, insomnia, weight loss, and passive suicidal ideation. His cardiologist referred him because his wife reports he 'isn't himself.' This case explores the distinction between adjustment disorder and MDD in the post-MI context, cardiac-safe antidepressant selection, critical drug interactions, and the evidence that untreated depression is an independent cardiac risk factor.

DepressionMDDPost-MI
intermediate~25 min

Grief vs Depression: When Does Mourning Become a Disorder?

A 67-year-old retired engineer presents 14 months after his wife's death with persistent depressive symptoms, raising the question of whether this represents prolonged grief disorder, bereavement-triggered MDD, or a longer-than-typical but normal grief process.

GriefDepressionMDD
intermediate~30 min

Irritability on Antidepressants

A 35-year-old IT project manager presents for an 8-week follow-up on sertraline 100mg for MDD. His depression has clearly improved (PHQ-9: 19 to 9), but he reports new-onset irritability, emotional volatility, and anger outbursts that are damaging his marriage and his relationship with his 6-year-old son. Navigate the differential diagnosis of SSRI-associated irritability — including emotional blunting, residual depression, akathisia, and emerging bipolarity — and develop a treatment plan that addresses both the pharmacological and relational dimensions of the problem.

SSRIsEmotional BluntingIrritability
intermediate~25 min

Partial Response Depression Plateau

A 44-year-old middle school history teacher presents for a 12-week follow-up on sertraline. His PHQ-9 has dropped from 21 to 11 — a meaningful improvement, but he remains symptomatic with prominent anhedonia and says he is 'going through the motions.' This case explores the clinical challenge of partial response in depression: when to optimize the current regimen, when to augment, when to switch, and why remission — not merely response — must be the treatment target. Most real patients live in this 'almost better' zone, and how you navigate it determines whether they recover or relapse.

DepressionSSRIPartial Response
intermediate~30 min

SSRI-Induced Hypomania vs True Bipolar

A 38-year-old graphic designer returns for a 2-week follow-up after starting escitalopram for MDD. She reports feeling 'amazing' — but sleeping 4-5 hours, starting multiple new projects, and talking faster than usual. Is this a genuine antidepressant response, SSRI activation syndrome, or emerging hypomania? Navigate the differential, medication decisions, and the difficult conversation with a patient who finally feels good.

Bipolar DisorderSSRIHypomania
advanced~25 min

The Accountant Whose Medications Aren't Working

A 48-year-old CPA presents frustrated after two 'failed' antidepressant trials. Walk through the systematic approach to treatment-resistant depression — verifying adequate trials, optimization, augmentation strategies, and advanced therapies.

DepressionTreatment ResistanceAugmentation
intermediate~25 min

The College Student Who Can't Sleep

A 21-year-old college junior presents with insomnia and academic failure. But the real diagnosis is hiding in the history. Walk through the full evaluation from presentation to follow-up.

Bipolar DisorderDiagnostic DilemmaOutpatient
advanced~30 min

The Lawyer Who Hasn't Slept in Five Days

A 36-year-old litigation attorney is brought to your clinic by his terrified law partner. He hasn't slept in five days, spent $40,000 on crypto, and stopped his lithium six weeks ago because he's 'cured.' Navigate the hospitalization decision, acute stabilization, and discharge planning for full-blown mania with psychotic features.

Bipolar IManiaAcute Stabilization
intermediate~25 min

The Man Who Hurts Everywhere

A 55-year-old long-haul truck driver is referred after 14 months of unexplained chronic pain, fatigue, GI complaints, and headaches. His medical workup is entirely negative, his PCP is frustrated, and Frank insists he's not depressed — he's sick. Learn to recognize depression when it speaks through the body, and how to meet a skeptical patient where he is.

DepressionSomatic SymptomsChronic Pain
advanced~30 min

The Mood Swings That Don't Add Up

A 33-year-old male EMT is referred for "bipolar not responding to treatment" after 6 months on lamotrigine. His "mood swings" don't follow bipolar patterns — they're rapid, reactive, and interpersonally driven. Navigate the critical differential between Bipolar II and Borderline Personality Disorder in a male patient, and learn why getting this wrong means treating the wrong diagnosis.

BipolarBPDPersonality Disorders
beginner~20 min

The Weight of Everything

A 34-year-old teacher presents with 3 months of worsening fatigue, anhedonia, and difficulty concentrating. Walk through the initial psychiatric evaluation, differential diagnosis, and treatment planning.

MDDPHQ-9SSRIs
intermediate~30 min

When Winter Is More Than Winter

A 29-year-old elementary school teacher presents proactively in early October, reporting four consecutive years of winter depressive episodes with full summer remission. She wants to prevent this year's episode before it takes hold. Navigate the diagnostic criteria for the seasonal pattern specifier, differentiate from other causes of winter worsening, and build a preventive treatment plan using light therapy, chronotherapy, and the only FDA-approved antidepressant for seasonal depression prevention.

Seasonal Affective DisorderMDDSeasonal Pattern

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💊 Psychopharmacology (70)🔍 Diagnosis & Assessment (58)📋 Treatment Planning (43)🗣️ Psychotherapy (50)