Single:

• The present of a single Major Depressive episode p365
• 5 or more symptoms occuring within a 2 week period;
• there is a visible change in functioning;
• at least 1 symptom shows a depressed mood or loss of interest/pleasure

Recurrent:

• Presence of 2 or more Major Depressive episodes
• Note: to be considered separate episodes, there must be a 2 consecutive mth interval in which criteria are not met for a Major Depressive episode

1. depressed mood-most of the day reported by clt (subjectively)
2. markedly reduced interest in all or most activities during the day
3. significant weight loss or gain; or reduced/increased appetite nearly everyday
4. insomnia or hypersomnia nearly everyday
5. psychomotor agitation or retardation (also observed by others)
6. fatigue or loss of energy everyday
7. feeling worthless and extreme/inappropriate guilt border on delusional daily
8. diminished ability to concentrate or think; indecisive daily
9. recurrent thoughts of death, recurrent suicide ideation w/out a plan, or attempt or w/a plan

• The Major Depressive episode is not better accounted for by Schizoaffective disorder and
• is not superimposed on Schizophrenia, Schizphreniform Disorder, Delusional disorder or Psychotic disorder NOS

• There has never been a Manic episode, a Mixed episode, or Hypomanic episode
• Note: this exclusion does not apply if all of the manic-like, mixed-like, hypomanic-like episodes are substance or treatment induced 
• or are due to the physiological effects of a gmc

If the full criteria are currently met for a Major Depressive episode, specify its current clinical status and/or features:

x1 MILD episode characterized by: p412

• few 5 or 6 depressive symptoms in excess of those required for dx
• with either mild disability or
• symptoms result in minor impairment in occupational functioning
• or usual social activities or relationships with others

 x2 MODERATE episode: Symptoms or functional impairment between mild to severe (intermediate severity)

x3 SEVERE w/out PSYCHOTIC features characterized by:

• several symptoms in excess of those required to make a dx
• symptoms markedly interferewith occupational functioning
• or with usual social activities or relationships with others
• clear-cut, observable disability

x4 SEVERE w/PSYCHOTIC features:

• presence of auditory delusions and hallucinations
• mood congruent psychotic features-content are depressive themes ersonal inadequacy, guilt, disease, nihilism, or deserved punishment
• mood incongruent psychotic features-does not include depressive themes
• include persecutory delusions, thought insertion, thought broadcasting

If the full criteria are not met for a Major Depressive episode, specify the current clinical status of the MDD or features of the most recent episode:

IN PARTIAL REMISSION:

• Symptoms of a Major Depressive episode are present but full criteria are not met
• or there is a period w/out any significant symptoms of a Major Depressive episode lasting less that 2mths following the end of Major Depressive episode

IN FULL REMISSION:

• during the past 2mths, no significant symptoms of the disturbance were present

CHRONIC:

• can be applied to most current Major Depressive episode in the Major Depressive Disorder
• and to a Major Depressive episode in Bipolar I or II Disorder
• Full criteria for Major Depressive episode have been met continously for at least the past 2yrs.

CATATONIC features:

• can be applied to most current Major Depressive episode, Manis episode, Mixed episode in Major Depressive Disorder
• and to a Major Depressive episode in Bipolar I or II Disorder
• The clinical symptoms of at least 2 or more of the following:
• motoric immobility (muscle rigidity) evident by waxy flexibility (catalepsy)
• excessive motor activity
• extreme negativism - resistance to movement
• peculiar voluntary movement/posturing
• echolalia -parrot-like repetition of word or phrase
• echopraxia - repetitive imitation of the movements of another person

• can be applied to current Major Depressive episode  in Major Depressive Disorder  and in Bipolar I or II disorder

Criterion A: Either of the following occurring during the current episode's most severe period:

1. loss of pleasure for all activities, anhedonia
2. lack of reactivity to pleasurable stimuli

Criterion B: 3 or more of the following:

1. distinct depressed mood
2. depression
3. early morning awakening (2hrs prior to rising)
4. marked psychomotor retardation or agitation
5. significant anorexia or wt loss
6. excessive inappropriate guilt

• can be applied when these features predominate during most recent 2wks of a current Major Depressive episode in Major Depressive Disorder and in Bipolar I or II Disorder
• or when these features predominate during the most recent 2yrs of Dysthmic disorder
• if Major Depressive episode is not current, it applies if the feature predominate during any 2wk period

Criterion A: mood reactivity (mood brighten when stimulated)

Criterion B: 2 or more of the following:

1. significant wt gain or increase in appetite
2. hypersomnia
3. leaden paralysis - heavy limbs
4. longstanding interpersonal rejection

POSTPARTUM onset:

• can be applied to the current Major Depressive , Manic, or Mixed episode in Major Depressive Disorder, Bipolar I or II Disorder, or Brief Psychotic disorder
• Episode onset within 4wks postpartum after giving birth
• labile mood
• feeling helpless to care for child
• completely uninterested in the child

Longitudinal Course:

• can be applied to Recurrent Major Depressive Disorder, Bipolar I or II Disorder
• with Full Interepisode Recovery: if full remission is attained between the two most recent Mood episodes
• without Full Interepisode Recovery: if full remission is not attained between the most recent Mood episode

SEASONAL PATTERN:

• can be applied to the pattern of Major Depressive episodes in Bipolar I or II Disorder, or Major Depressive Disorder, Recurrent

Criterion A:

• temporal relationship between onset of Major Depressive episodes in Bipolar I or II disorder, or Major Depressive disorder Recurrent
• and a particular time of the year
• Note: do not include cases -there is an obvious seasonal affect related to psychosocial stressors (ex. being unemployed during Winter mths

Criterion B: Full remissions (or a change from depression to mania or hypomania) also occur at characteristic time of the year (ex. depression disappears in Spring)

Criterion C:

• in last 2yrs-2 Major Depressive episodes have occurred demonstrated in temporal seasonal relationships defined in criteria A and B
• and no nonseasonal Major Depressive episodes have occurred during that same period

Criterion D: seasonal Major Depressive episodes outnumbered the nonseasonal Major Depressive episodes that may have occurred over the person's lifetime

• depressed mood most of the day
• reported subjectively or observed by others
• for minimum 2yrs
• Note: in children/adolescents - irritable mood duration 1yr minimum

while depressed, 2 or more symptoms present:

1. poor appetite or overeating
2. insomnia or hypersomnia
3. fatigue
4. low self-esteem
5. poor concentration
6. feeling of hopelessness

• No Major Depressive episode have been present during first 2yrs of disturbance
• the disturbance is not better accounted for by chronic Major Depressive disorder or Major Depressive disorder, in partial remission

• There has never been a manic, mixed, hypomanic episodes
• and criteria has never been met for Cyclothymic disorder

• Early onset: If onset is before age 21yo
• Late onset: If onset is age 21yo or older

Specify for most recent 2yrs of Dysthymic disorder

• can be applied when these features predominate during most recent 2wks of a current Major Depressive episode in Major Depressive Disorder
• or in a current Major Depressive episode Bipolar I or II Disorder
• or when these features predominate during the most recent 2yrs of Dysthymic disorder
• if Major Depressive episode is not current, it applies if the feature predominate during any 2wk period

Criterion A: mood reactivity (mood brighten when stimulated)

Criterion B: 2 or more of the following:

1. significant wt gain or increase in appetite
2. hypersomnia
3. leaden paralysis - heavy limbs
4. longstanding interpersonal rejection

criterion A:

• only 1 Manic episode present and no past Major Depressive episode
• a distinct period of abnormally persistent elevated, expansive, irritable mood - 1 wk in duration

criterion B:

• Manic episode not better accounted for by Schizoaffective disorder 
• and is not superimposed Schizophrenia, Schizoform, Delusional disorder, Psychotic NOS disorder

Symptoms:

3 or more symptoms present during mood disturbance with significant intensity:

• inflated self-esteem or grandiosity
• decreased need to sleep
• more talkative than usual
• flight of ideas or racing thoughts
• easily distracted
• increased goal-directed activity:
• psychomotor agitation or socially
• excessive involvement in pleasurable things

• Mixed: if symptoms meet criteria for a mixed episode

If the full criteria are met for manic, mixed, major depressive episode, specify its current clinical status/features:

• x1 mild,
• x2 moderate,
• x3 severe w/out psychotic features,
• x4 sever w/psychotic features
• with catatonic features
• with postpartum features

If the full criteria are not met for a Major Depressive episode, specify the current clinical status of the MDD or features of the most recent episode

• in partial remission
• in full remission
• with catatonic features
• with postpartum features

1. criterion A: Currently in hypomanic episode

• a distinct period of persistently elevated expansive, or irritable mood,
• lasting thru at least 4 dys
• clearly different from nondepressed mood

2. criterion B: There has been previously 1 Manic or Mixed episode

3. criterion C:

• The mood symptoms cause clinical significant distress
• or impairment in social, occupational functioning

Symptoms:

during the period of mood disturbance, 3 or more of the following symptoms have persisted, (4 if mood is irritable) and present:

1. inflated self-esteem or grandiosity
2. decrease need for sleep
3. more talkative or pressure to keep talking
4. flight of ideas or thoughts racing
5. easily distracted
6. increased goal-directed activities
7. excessive involvement in pleasurable activities

4. criterion D:

• The mood episode in criteria A and B are not better accounted for by Schizoaffective disorder
• and not superimposed by Schizophreniform, Schizophrenia, Delusional, Psychotic NOS disorders

Longitudinal course:

• can be applied to Recurrent Major Depressive Disorder, Bipolar I or II Disorder
• with Full Interepisode Recovery: if full remission is attained between the two most recent Mood episodes
• without Full Interepisode Recovery: if full remission is not attained between the most recent Mood episode

With Seasonal pattern: applies only to MD episode

With Rapid Cycling: p427

• can be applied to Bipolar I or II disorders
• at least 4 episodes of mood disturbances
• in the previous 12mth
• that meet criteria for MD, manic, mixed, hypomanic episodes

criterion A:

• Currently in a Manic episode
• a distinct period of abnormally persistent elevated, expansive, irritable mood - 1 wk in duration

criterion B: At least 1 MD, manic, or mixed episode

criterion C:

• The mood episodes in criteria A and B are not better accounted for by Schizoaffective disorder and
• is not superimposed on Schizophrenia, Schizphreniform Disorder, Delusional disorder or Psychotic disorder NOS

If the full criteria are met for manic, mixed, major depressive episode, specify its current clinical status/features:

• x1 mild,
• x2 moderate,
• x3 severe w/out psychotic features,
• x4 sever w/psychotic features
• with catatonic features
• with postpartum features

If the full criteria are not met for a Major Depressive episode, specify the current clinical status of the MDD or features of the most recent episode

• in partial remission
• in full remission
• with catatonic features
• with postpartum features

 Longitudinal course:

•  can be applied to Recurrent Major Depressive Disorder, Bipolar I or II Disorder
• with Full Interepisode Recovery: if full remission is attained between the two most recent Mood episodes
• without Full Interepisode Recovery: if full remission is not attained between the most recent Mood episode

 With Seasonal pattern: applies only to MD episode

 With Rapid Cycling: p427

•  can be applied to Bipolar I or II disorders
• at least 4 episodes of mood disturbances
• in the previous 12mth
• that meet criteria for MD, manic, mixed, hypomanic episodes

1. criterion A: Currently in a Major Depressive  episode
2. criterion B: At least 1 manic, or mixed episode
3. criterion C:

• The mood episodes in criteria A and B are not better accounted for by Schizoaffective disorder and
• is not superimposed on Schizophrenia, Schizphreniform Disorder, Delusional disorder or Psychotic disorder NOS

If the full criteria are met for manic, mixed, major depressive episode, specify its current clinical status/features:

• x1 mild,
• x2 moderate,
• x3 severe w/out psychotic features,
• x4 sever w/psychotic features
• chronic
• with catatonic features
• with melancholic deatures
• with atypical features
• with postpartum features

If the full criteria are not met for a Major Depressive episode, specify the current clinical status of the MDD or features of the most recent episode

• in partial remission
• in full remission
• chronic
• with catatonic features
• with melancholic features
• with atypical features
• with postpartum features

Longitudinal course:

• can be applied to Recurrent Major Depressive Disorder, Bipolar I or II Disorder
• with Full Interepisode Recovery: if full remission is attained between the two most recent Mood episodes
• without Full Interepisode Recovery: if full remission is not attained between the most recent Mood episode

With Seasonal pattern: applies only to MD episode

With Rapid Cycling: p427

1. criterion A: Criteria except for duration are currently met for a manic , hypomanic, mixed, or MD episode

2. criterion B: At least 1 Manic or Mixed episode

3. criterion C:

• The mood symptoms cause clinical significant distress
• or impairment in social, occupational functioning

4. criterion D:

• The mood episode in criteria A and B are not better accounted for by Schizoaffective disorder
• and not superimposed by Schizophreniform, Schizophrenia, Delusional, Psychotic NOS disorders

5. criterion E: The mood symptoms in criteria A and B are due to the physiological effects of a gmc

Longitudinal course:

• can be applied to Recurrent Major Depressive Disorder, Bipolar I or II Disorder
• with Full Interepisode Recovery: if full remission is attained between the two most recent Mood episodes
• without Full Interepisode Recovery: if full remission is not attained between the most recent Mood episode

With Seasonal pattern: applies only to MD episode

With Rapid Cycling: p427

1. criterion A: Presence or hx of 1 or more Major Depressive episode

2. criterion B: Presence or hx of al least 1 Hypomanic episode

3. criterion C: There has never been a manic or mixed episode

4. criterion D:

• The mood episode in criteria A and B are not better accounted for by Schizoaffective disorder
• and not superimposed by Schizophreniform, Schizophrenia, Delusional, Psychotic NOS disorders

5. criterion E:

•  The mood symptoms cause clinical significant distress
• or impairment in social, occupational functioning

Hypomanic: If currently in a hypomanic episode

Depressed: If currently in a Major Depressive episode

If the full criteria are met for manic, mixed, major depressive episode, specify its current clinical status/features:

• x1 mild,
• x2 moderate,
• x3 severe w/out psychotic features,
• x4 sever w/psychotic features
• chronic
• with catatonic features
• with melancholic deatures
• with atypical features
• with postpartum features

If the full criteria are not met for a Major Depressive episode, specify the current clinical status of the MDD or features of the most recent episode

• in partial remission
• in full remission
• chronic
• with catatonic features
• with melancholic features
• with atypical features
• with postpartum features

Longitudinal course:

• can be applied to Recurrent Major Depressive Disorder, Bipolar I or II Disorder
• with Full Interepisode Recovery: if full remission is attained between the two most recent Mood episodes
• without Full Interepisode Recovery: if full remission is not attained between the most recent Mood episode

With Seasonal pattern: applies only to MD episode

With Rapid Cycling: p427

• The mood episode in criteria A are not better accounted for by Schizoaffective disorder
• and not superimposed by Schizophreniform, Schizophrenia, Delusional, Psychotic NOS disorders

• The mood symptoms are not due to the physiological effects of a substance or gmc.