Mood Disorders & Mood Episodes

Mood disorders are characterized by having mood episodes.  I will here define the types of mood episodes: major depressive episode, manic episode, mixed episode and hypomanic episode.  The presence of these mood episodes will define mood disorders, which will be covered in subsequent posts.

Major Depressive Episode

• 5 or more of the following symptoms during the same 2 week period; must have either depressed mood or loss of interest/pleasure.
• Depressed mood for most of the day, nearly every day, as indicated by either self report or observation made by others. (In children/adolescents, mood by be irritable, rather than classically depressed.)
• Diminished pleasure in all or nearly all activities for most of the day nearly every day.  Again, this may be indicated by self report or observation made by others.
• Weight loss or gain (more than 5% in a month), or increase or decrease in appetite nearly every day.  (In children/adolescents, look for the child not to gain weight as expected.
• Insomnia/hypersomnia nearly every day.
• Psychomotor agitation/retardation nearly every day (must be observable by others; not just feelings of restlessness or being slowed down).
• Fatigue/loss of energy nearly every day.
• Feelings of worthlessness/excessive or inappropriate guilt nearly every day.  Guilt may be delusional & must be more than just self-reproach about being sick.
• Diminished ability to think, concentrate or make decisions nearly every day, indicated by either self report or observations of others.
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan or a suicide attempt or suicide plan.
• Symptoms do not meet the criteria for a mixed episode.
• Symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning.
• Symptoms are not due to the direct physiological effects of a substance or a general medical condition.
• Symptoms are not better accounted for by bereavement.  Diagnosis may be made if the symptoms persist for longer than two months, or are characterized by marked functional impairment.

Manic Episode

• Period of abnormally & persistently elevated, expansive or irritable mood, lasting at least one week (or less if hospitalization is required).
• During the period, three or more of the following symptoms have persisted (four if the mood is only irritable), and the symptoms have been present to a significant degree:
• Inflated self esteem/grandiosity
• Decreased need for sleep (feeling rested after only a few hours)
• More talkative than usual/pressure to keep talking
• Flight of ideas or report of racing thoughts
• Distractibility
• Increase in goal-directed activity in any life sphere or psychomotor agitation
• Excessive involvement in pleasurable activities that have a potential for danger or harm (shopping sprees, gambling, risky investments).
• The symptoms do not meet the criteria for a mixed episode.
• The mood disturbance causes marked impairment in social or occupational functioning.  If there is psychosis, this criterion is considered to have been met.
• The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

Mixed Episode

Mixed episodes may evolve out of a manic or major depressive episode, or can arise on their own.  A mixed episode can turn into a major depressive episode, or may remit to an asymptomatic period.  It is unusual for a mixed episode to turn into a manic episode.  Mixed episodes, by definition, must last longer than one week.

• The criteria are met both for a manic & a major depressive episode (except for duration) for at least one week.
• The symptoms must cause impairment in social or occupational functioning, require hospitalization, or have psychotic features.
• The symptoms are not caused by the direct physiological effects of a substance or a general medical condition.

Hypomanic Episode

Hypomanic episodes are essentially manic episodes that do not cause impairment in functioning.  The criteria are below, and you will find that the criteria are identical to the criteria for a manic episode except for the difference noted above & shorter duration.

• Period of persistently elevated, expansive or irritable mood, lasting at least 4 days & is clearly different from the normal nondepressed mood.
• During the period, three or more of the following symptoms have persisted (four if the mood is only irritable), and the symptoms have been present to a significant degree:
• Inflated self esteem/grandiosity
• Decreased need for sleep (feels rested after only a few hours)
• More talkative than usual/pressure to keep talking
• Flight of ideas or report of racing thoughts
• Distractibility
• Increase in goal-directed activity in any life sphere or psychomotor agitation
• Excessive involvement in pleasurable activities that have a potential for danger or harm (shopping sprees).
• The episode is associated with an unequivocal change in functioning that is not typical of the person when they are not having symptoms.
• The disturbance is observable by others.
• The mood disturbance does not cause marked impairment in social or occupational functioning. 
• The symptoms are not due to the direct physiological effects of a substance or a general medical condition.