Symptoms

Reduced need for sleep for a few days without feeling tired

Sleep disruptions (e.g., shift work; childcare; travel; time change; change in season, especially spring and fall) that trigger a manic or hypomanic event

Atypical depression: hypersomnia, increased appetite, psychosis, pathologic guilt, labile mood

Racing thoughts that prevent sleep initiation

Irritability, impulsivity, irrationality

Mood swings (irregular changes from low to high) or periods of intense goal orientation

Family history

Relative with a bipolar disorder

Multiple relatives with any of the following: depression, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, anxiety, panic disorder

Family history of multiple instances of suicide, incarceration, drug or alcohol abuse

Personal history

Multiple divorces

Prior episodes of depression, especially with early onset (age 13 years or younger) or seasonal variability

No response to three or more antidepressant trials

Legal or financial problems

Attempted suicide

Drug or alcohol abuse

Recurrent job loss

Intolerance of an antidepressant, steroid, or other medication, especially if it caused agitation or mania

Prior episodes of mania or hypomania