Persistent Depressive Disorder (Dysthymia)

Individuals suffering from Persistent Depressive Disorder evidence a chronically depressed mood that occurs for most of the day, more days than not, for at least a two year period.  The impairment and depressed mood are usually not as severe as in Major Depression.  Two of the following symptoms must also be present:

• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration
• Feelings of hopelessness
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth  Edition, text Revision. Washington, DC American Psychiatric Association, 2000.

Major Depressive Disorder

Persons with Major Depressive Disorder experience, at least, a two week period of suffering either a depressed mood or the loss of interest or pleasure in nearly all activities.  In addition, at least four of the following must be met:

• Change in appetite or weight
• Change in sleep
• Decreased energy
• Feelings of worthlessness or guilt
• Difficulties in concentrating
• Psychomotor changes (agitation, lethargy)
• Recurrent thoughts of death or suicidal ideation, plan, or intent

There is also impairment in social, occupational, and other important areas of functioning in one’s life.  In general, individuals feel “down in the dumps”, “sad”, “hopeless”, etc.  In children and adolescents, an irritable mood may be present as opposed to sadness.  Studies indicate that depressive episodes occur twice as much in women than in men.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth  Edition, text Revision. Washington, DC American Psychiatric Association, 2000.

Bipolar I Disorder

Individuals with Bipolar I Disorder have experienced one or more Manic or Mixed Episodes and often have had one or more Depressive Episodes, though a Depressive Episode is not necessary to meet diagnosis criteria.  A Manic Episode is marked by a significant period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week.  Additional characteristics include at least three of the following or four if the mood is irritable:

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative and/or pressure to keep talking
• Flight of ideas or racing thoughts
• Distractibility
• Increase in goal directed activity
• Excessive involvement in pleasurable activities with a potential for negative consequences

There is also marked impairment in social and occupational functioning.

A Mixed Episode is defined by a period of time (at least 1 week) in which, the criteria for a Major Depressive Episode and a Manic Episode are both met.  This period is marked by a rapidly changing mood.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth  Edition, text Revision. Washington, DC American Psychiatric Association, 2000.

Bipolar II Disorder

Bipolar II Disorder is defined by the presence of a Major Depressive Episode and at least one Hypomanic Episode (a distinct period of elevated., expansive, or irritable mood lasting, at least, 4 days)  The criteria for a Hypomanic Episode are as follows and include at least three of the following:
 
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative and/or pressure to keep talking
• Flight of ideas or racing thoughts
• Distractibility
• Increase in goal directed activity
• Excessive involvement in pleasurable activities with a significant potential for negative consequences

A Hypomanic Episode is not severe enough to cause major impairment in social or occupational functioning.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth  Edition, text Revision. Washington, DC American Psychiatric Association, 2000.