MDQ
Mood Disorder Questionnaire
Self-report screen for lifetime bipolar spectrum — used to surface possible hypomania missed in depression-focused assessments.
When to use the MDQ
Use the MDQ before starting or recommending an antidepressant, and any time a depressed client reports periods of elevated mood, reduced need for sleep, or impulsivity. It screens for a bipolar-spectrum history that changes treatment entirely.
What the MDQ measures
Section 1: 13 yes/no items on lifetime hypomanic/manic symptoms. Section 2: whether several symptoms occurred together. Section 3: functional impairment from those episodes.
Use the MDQ when
- Any positive depression screen, before a medication referral
- Reported mood cycling, irritable highs, or reduced sleep need with high energy
- Antidepressant non-response, rapid response, or activation on an SSRI
- Family history of bipolar disorder
Why use the MDQ instead of another measure
Missing bipolarity is one of the highest-consequence errors in mental-health care because antidepressant monotherapy can precipitate mania. The MDQ is 13 yes/no items plus two qualifiers and takes under five minutes to rule the question in or out.
When not to use the MDQ
- You intend to treat the screen as a diagnosis — a positive MDQ requires a clinical interview
- The client has borderline personality features or ADHD; both inflate false positives
- Screening children or young adolescents
Scoring and bands
Cutoffs
All three sections must meet criteria for a positive screen. Sensitivity for bipolar I is good (~73%); sensitivity for bipolar II is weaker. Specificity around 90% in psychiatric samples.
What MDQ results mean — and what to do next
Fewer than 7 symptoms, or no co-occurrence, or no moderate impairment.
Next stepProceed with unipolar treatment; re-screen if a client activates on medication.
≥7 symptoms that co-occurred and caused at least moderate problems.
Next stepRefer for a diagnostic psychiatric evaluation before any antidepressant monotherapy; ask about family history and past episodes.
How often to re-administer
At intake and again whenever mood cycling or medication activation appears.
What to pair it with
PHQ-9 (current depressive severity) and AUDIT (substance-induced mood elevation is a common confound).
How to talk about the score
A positive MDQ is a prompt for a careful clinical interview about lifetime hypomania, not a diagnosis. Many clients with recurrent depression who screen positive turn out to be unipolar; misclassification of medications has consequences either direction.
Limitations
- Under-detects bipolar II
- Specificity drops in non-psychiatric samples
- Doesn't distinguish irritability from euphoria
- Past-episode reporting unreliable in active depression
Best used for
- Surfacing possible bipolar history when depression is the presenting concern
- Pre-medication consultation
- Adjunct to clinical interview
Frequently asked questions about the MDQ
Should every depressed client get an MDQ?
Many guidelines suggest yes — bipolar is frequently missed in depression presentations, and the cost of missing it is high (antidepressant monotherapy can destabilize mood).
What if a client screens positive but has never had a clear hypomanic episode?
Investigate further with structured questions about prior 'good periods' that included reduced sleep need, racing thoughts, etc. Collateral from family is often valuable.