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Printed on 7/20/2026
For informational purposes only. This is not medical advice.
The MDQ is a structured bipolar-spectrum screening tool that combines endorsed manic/hypomanic symptom count with symptom co-occurrence and functional impact criteria.
Formula: Common positive screen pattern: symptom count >= 7, same-period clustering present, and moderate or serious impairment.
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The MDQ Part 1 presents 13 yes/no questions asking about lifetime experiences of manic or hypomanic symptoms: unusually elated or expansive mood, decreased need for sleep with sustained energy, rapid speech with pressure to keep talking, racing thoughts or rapid thinking, easily distracted, increased energy and activity, increased social/sexual/occupational activity or risk-taking, grandiosity or inflated self-confidence, spending sprees or poor financial decisions, sexual indiscretions, increased goal-directed activity, agitation or irritability, and risky or unusual behavior. These represent the core DSM features of mania and hypomania.
MDQ Part 2 asks a single yes/no question: 'If you checked YES to more than one of the above, have several of these symptoms ever occurred DURING THE SAME PERIOD OF TIME?' This clustering criterion is essential to distinguish episodic bipolar mood episodes from isolated personality traits, ADHD symptoms, or chronic characterological features. A patient may endorse 10 of 13 symptoms but if they occurred in different life periods, the MDQ positive criteria are not met.
An MDQ positive screen requires ALL THREE criteria: (1) 7 or more of 13 symptoms endorsed as yes, (2) symptoms occurring in the SAME time period (Part 2 = yes), and (3) moderate or serious functional problems attributed to those symptoms (Part 3 = moderate or serious). Meeting only one or two criteria does NOT constitute a positive screen. A positive MDQ result requires psychiatric evaluation — it does not diagnose bipolar disorder but identifies patients who warrant comprehensive mood disorder assessment.
General Practitioners
The MDQ is recommended for screening in primary care when patients present with recurrent depression, treatment-resistant depression, or risk factors for bipolar disorder (family history, early onset depression). It takes 5 minutes and can be self-administered in the waiting room.
Psychiatrists
At psychiatric intake, the MDQ provides a standardized lifetime screen for bipolar spectrum features that complements the clinical interview. A positive MDQ redirects the diagnostic formulation toward bipolar disorder and changes treatment planning fundamentally.
Psychiatrists and PCPs
Up to 20% of patients with treatment-resistant depression may have unrecognized bipolar disorder. The MDQ should be routinely administered before escalating antidepressant doses or adding augmentation agents, as antidepressants without mood stabilizers in bipolar disorder can trigger mania or rapid cycling.
Clinical Researchers
The MDQ is widely used in epidemiological studies and clinical trials as an efficient lifetime screening tool for bipolar disorder. Its 13-item structure provides a standardized, reproducible classification of bipolar-spectrum symptom history across large research populations.
Patients and Families
First-degree relatives of bipolar disorder patients have 5-10 times higher risk of developing bipolar disorder. The MDQ provides a structured lifetime screen for individuals with family history who are concerned about their own mood stability.
The MDQ asks about lifetime experiences of manic/hypomanic symptoms, not current or recent mood state. A patient who is currently depressed and has never been manic will screen negative, but a patient who had a hypomanic episode years ago will screen positive. This lifetime approach is essential because bipolar disorder is frequently first diagnosed during a depressive phase, and patients often do not spontaneously report past manic or hypomanic episodes as pathological.
Bipolar disorder is one of the most frequently misdiagnosed psychiatric conditions. Patients with bipolar disorder most commonly present to healthcare during depressive episodes and are often initially diagnosed with unipolar depression. The average delay between first symptoms and correct bipolar diagnosis is 6-10 years. Routine MDQ screening in patients with recurrent depression, antidepressant non-response, or treatment-resistant depression is the most effective way to shorten this diagnostic delay.
A positive MDQ result (7+ symptoms, same period, moderate+ impairment) is a positive screen, not a diagnosis. Bipolar disorder diagnosis requires comprehensive psychiatric evaluation including detailed mood episode history, family history, symptom timeline, rule-out of substance-induced or medical causes, and longitudinal observation. Do not prescribe mood stabilizers or change treatment based solely on a positive MDQ without full psychiatric evaluation.
One of the most important clinical consequences of missed bipolar disorder diagnosis is the use of antidepressant monotherapy, which can trigger manic or hypomanic episodes, induce mixed states, and cause rapid cycling in bipolar disorder. Always administer the MDQ before starting or escalating antidepressants in patients with recurrent depression or treatment non-response. A positive MDQ should prompt psychiatric consultation before antidepressant treatment decisions.
In the original Hirschfeld et al. (2000) validation, MDQ sensitivity was 0.73 for bipolar I but only approximately 0.50 for bipolar II. This lower sensitivity for bipolar II occurs because hypomanic episodes — by definition — produce less impairment than manic episodes, and patients with bipolar II may endorse fewer symptoms and lower functional impairment, making it more difficult to reach the 7-symptom and moderate impairment thresholds. A negative MDQ does not rule out bipolar II.
In patients with major depression who have failed two or more antidepressant trials, the probability of unrecognized bipolar disorder increases substantially. Studies show that 15-20% of patients diagnosed with treatment-resistant unipolar depression actually have bipolar disorder. Before adding a third antidepressant, an antipsychotic augmentation agent, or a mood stabilizer, administer the MDQ. A positive result should redirect evaluation toward bipolar disorder, which changes medication choices fundamentally.
The treatment of bipolar depression differs fundamentally from unipolar depression. First-line agents with evidence for bipolar depression include lithium, lamotrigine (particularly for bipolar II), and quetiapine. Antidepressants without a mood stabilizer are generally not recommended as monotherapy for bipolar depression due to risks of manic switch and cycle acceleration. Patients identified by positive MDQ who are found to have bipolar disorder at psychiatric evaluation should have antidepressants tapered and mood stabilizers initiated.
Lithium remains the gold-standard mood stabilizer with evidence for reducing both manic and depressive episodes and for suicide prevention in bipolar disorder. However, it has a narrow therapeutic window (target serum level 0.6-1.2 mEq/L for maintenance). Toxicity occurs above 1.5 mEq/L. Regular monitoring includes serum lithium levels (every 3-6 months when stable), renal function (lithium can cause nephrogenic diabetes insipidus), and thyroid function (lithium causes hypothyroidism in up to 40% long-term). Hydration status critically affects lithium levels — dehydration or sodium restriction elevates levels to toxic range.
A fundamental challenge in bipolar II diagnosis is that hypomanic episodes may be experienced as highly productive, pleasant, energetic periods — the patient's 'best self' — rather than as illness. Unlike mania, which by definition causes significant functional impairment, hypomania produces only moderate impairment. Patients may not recall hypomanic periods as symptomatic and may describe them positively. When reviewing the MDQ with a patient, explore whether the endorsed symptoms ever corresponded to a period others found concerning, when sleep was substantially reduced, or when spending or behavior led to regret.
MDQ published by Hirschfeld et al. (Am J Psychiatry 2000) from 198 outpatients. Sensitivity 0.73 and specificity 0.90 for bipolar I disorder vs unipolar depression. Bipolar II sensitivity 0.50. Average diagnostic delay 6-10 years: Suppes et al. (Bipolar Disord 2001). MDQ use in treatment-resistant depression: Ghaemi et al. (J Clin Psychiatry 2001). CANMAT 2018 Bipolar Disorder Guidelines recommend MDQ for bipolar screening in depressed patients. Bipolar disorder prevalence: approximately 1-2% (bipolar I) and 0.4-1.5% (bipolar II) in the general population.
Meeting the common positive MDQ pattern suggests bipolar-spectrum symptoms may be present and supports formal mood-disorder diagnostic assessment.
Use when bipolar-spectrum symptoms are suspected, especially before initiating or escalating long-term antidepressant therapy.
Screening performance varies by setting and comorbidity. The MDQ does not replace longitudinal clinical history, collateral information, or formal diagnostic interview.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
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