Major and Manic Depressive Episode

The essential feature of a Major Depressive Episode is a period of at least two weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities. In children and adolescents, the mood may be irritable rather than sad.To count toward a Major Depressive Episode, a symptom must either be newly present or must have clearly worsened compared with the person’s pre-episode status. The symptoms must persist for most of the day, nearly every day, for at least 2 consecutive weeks. The episode must be accompanied by clinically significant distress or impairment in social,occupational, or other important areas of functioning.For some individuals with milder episodes, functioning may appear to be normal, but requires  markedly increased effort.

Criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the two week period and represent a change from previous functioning; at least one of the symptoms is either

(1) depressed mood

or

(2) loss of interest or pleasure.

Note:
Do not include symptoms that are clearly due to a general medical condition, or mood-in congruent delusions or hallucinations.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).

Note: In children and adolescents, can be irritable mood.

2. Markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5%of body weight in a month), or decrease or increase in appetite nearly every day.Note: In children, consider failure to make expected weight gains.

4. Insomnia or hypermedia nearly every day

5. Psycho motor agitation or retardation nearly everyday(observable by others, not merely subjective feelings of restlessness or being slowed down).

6. Fatigue or less of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

9. Recurrent thoughts of death(not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication)or a general medical condition(e.g.,hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2months or are characterized by marked functional impairment,morbid pre occupation with worthlessness, suicidal ideation, psychotic symptoms, or psycho motor retardation.

Criteria for Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1week (or any duration if hospitalisation is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6. increase in goal-directed activity(either socially,at work or school,or sexually) or psycho motor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

8. The symptoms do not meet criteria for a Mixed Episode.

9. The mood disturbance is sufficiently severe to cause marked impairment in occupational  functioning or in usual social activities or relationships with others, or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features.

10. The symptoms are not due to the direct physiological effects of a substance (e.g., drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).