Understanding Mood Episodes in Depression - Depression Resources, Education About Depression and Unipolar Depression

The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), which describes the criteria necessary for the diagnosis of all mental disorders, including Major Depression. In the DSM, Major Depression appears as a member of the Depressive Disorders category, which also includes the Bipolar Disorders, Dysthymic Disorder, Cyclothymia and Depressive Disorder Not Otherwise Specified. These various mood disorders are all similar in that they all have something to do with disordered mood, and more specifically, with depressed mood. They are distinguished by the extent and severity of a person's mood disturbance, and by the direction (up or down) of the moods involved.

Here is a key point: The mood disorder diagnoses are essentially defined as patterns of mood disturbances observed through time. Clinicians choose from among the various mood-related diagnoses on the basis of their observation of patients' sequence of mood episodes. Most people with mood disorders will have (or have already had) a history of multiple mood episodes. Individual mood episodes last for several weeks or months and then give way to normal mood, or to another mood episode.

In order to fully understand how mood disorders are defined, you first have to understand the concept of mood episodes. There are four kinds of mood episodes described in the DSM: Major Depressive, Manic, Hypomanic, and Mixed. Major Depressive episodes are characterized by the classic symptoms described above. Manic episodes are characterized by a persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). In addition, three (or more) of the following symptoms must be present (four symptoms must be present if the person's mood is only irritable):

Hypomanic episodes are a milder form of manic episodes. Both share the same list of symptoms described above. However, the DSM criteria for Hypomanic episodes state that the person's mood disturbance occurs throughout at least 4 days (rather than 1 week as with a Manic Episode).

Mixed episodes are essentially a combination of manic and depressive episodes that become superimposed so that symptoms of both are present (at different times) during the same day. More specifically, the criteria are met both for a Manic Episode and for a Major Depressive Episode nearly every day during at least a 1-week period.

Major Depression is a distinct and separate condition from Bipolar Disorder and the other mood disorders. By definition, people diagnosed with Major Depression show only a history of one or more major depressive episodes. People with Major Depression never have a history of manic or mixed episodes, and neither do they show signs of hypomania. People with Major Depression also have relatively severe mood symptoms. People who show signs of depressive mood on a regular basis but who do not meet the formal criteria for a depressive mood episode cannot be diagnosed with Major Depression. Such individuals will instead tend to have some other mood diagnosis, such as Dysthymic Disorder.

In this article, we focus on the Unipolar forms of depression; namely Major Depressive Disorder, Dysthymic Disorder, and Depressive Disorder Not Otherwise Specified. The other mood disorders tend to be variations on the theme of bipolar disorder and are discussed in our Bipolar Disorders Topic Center. Throughout our discussion it is important to keep in mind that the term "depression" is not particularly specific. There are multiple kinds of depression; and the diagnosis of a particular disorder varies depending on the severity, duration, and persistence of symptoms.

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I read some of these comments, and apparently, I am not in this roller-coaster called life by myself. I also have tried to get help for my depression, but the Psychiatrist thinks I have a personality disorder, not depression, so he won't medically treat me. I feel nobody is listening to me. I know I'm depressed and the Psychiatrist thinks once a month visit with the therapist is what I need. I asked, what about the days between our visits, I'm on my own. It seems that only individuals who are going through this understand. Maybe, we should start counseling each other. I don't know what the answer is, 'cause I believe that there's no professional help anyway.

I've been suffering from night terrors, sleep disruptions and depression for as long as I can remember. I'm 18 now and no matter how many doctors, and psychologists I see they keep telling me its in my head. The sleep disruptions have been affecting my schooling and work life. I just feel so paranoid and tired all the time, there is nothing that can comfort me. Every time I try to see what they can do they imply that I have Hypochondriasis. That is certainly not the case as it has been proven that I am in poor health. They seem to only address my physical pain never the mental. Is there anything I can do?

All I know is that I've suffered from severe deppression/anxiety for a very long time. I just turned 31 and I feel as if I've been suffering from this my entire life. Been hospitalized several times. Been on almost every type of anti depressant there is. Seen several of psychologists and psychiatrists over the years and still I have not gotten any better, only worst. I've tried to get help from churches and pastors and no one can or will help me. I have no family and the friends I had, I cut off because I felt like no one can understand how I feel all they can do is criticize me. I cannot account for how many times I've attempted suicide and have not been successful. The only reason why I am still breathing is because I have a 10 yr old daughter who have no one in this world but me and I have no one in this world but her. You would think that would be enough to get better and to want to continue living.

Life can become so overwhelming that the most important person in one's life might not be enough for one to continue. I always felt like no one in the world could understand how I feel. By reading other people comments, I'm starting to think maybe someone else in the world just might understand.

If I have no support and no one will help me through this how can I have hope that one day I'll be okay?

u all guyz juz feel n think datz crazy sick person's unnormal fo u, isnt it ?! in d fack we're not crazy juz uniQ . .

help me i feel like a body without a soul like a caged black bird,i feel like a zombie or a lost ghost, help, its feels like ur dying many times a day, its like a hole the more you want to come out of it the more u sink in it,this what is called depression and only ones who really experienced it will agree with me.

I've been depressed numerous times, for various reasons, and i know i'm not out of the woods yet. but hopefully i'm getting there. I just flicked on to this site and read some of the comments and there was a remark about living being hard and suicide being the 'easy way out'.

Anyway, what i wanted to say was back when i was in the deep dark pits and i considered suicide i never once thought it was easy. Even though you feel your life is really hard and you don't want to go on, it's not easy considering death as your only option. i kept thinking to myself 'if i get hit by a bus today and die, that would be great' but whenever i actually considered doing the deed myself . . . all i could think about was 'what if i'm not successful?' then my parents would suddenly know what i was prepared to do and they'd keep bugging me and making me feel guilty etc and i didn't want that. I hated feeling alone and in pain but i didn't want a big fuss and loads of attention.

I've always thought that suicide takes guts but maybe that's just me. Staying alive . . . that takes guts too and i know for a long while i was practically dead anyway. I'm not saying that suicide is more difficult than life because life is tough, no doubt about it. i'm just saying that people put emphasis on suicide being the easy way out when i don't think it is. in all honesty, i'm not sure there is an easy way out of being depressed. I know suicide is 'giving up' whereas life is 'fighting' or whatever but i doesn't make suicide the easy way out. for instance, sometimes with me, thinking of all the ways i could die that day were sometimes all that got me through. the idea that it could all be over any minute . . . it's sounds odd but it kind of gave me hope. hope that if i could just make it through the next minute then i wouldn't have to fight anymore. i don't think that suicide is giving up. it's just where you want peace and stuff. you're tired and you need to rest.

Like i said, i don't feel out of the woods yet and its probably been around a year since my last really bad episode. i still have really low days or weeks and in that time i just feel totally hopeless. it's like people say that your teen years are meant to be the best of your life and that just makes me think that it can only go downhill from here. I think the only things that have pulled me through are my bestfriend, who's been down the depression road herself, and dreams of travelling the world and seeing amazing things. I have some other dreams too and sometimes closing my eyes and drifting off into a day dream about them are all i can do not to get pulled under by depression. some of them i know will never come true and it hurts to know that but they are a useful tool to just stop or slow the bad descent into a black hole because at that point you don't care that they'll never come true. You just cling to any hope you can get.

I don't have any advice or anything. i wish i did but i don't. i just really wanted to make that point about suicide not being the easy way out. because it's not. life or suicide. When those are your options, there simply isn't an easy way.

I have lived this way for so long and so far no improvement. No medication can help. Can't find a treatment that makes life bearable. We have tried them all. I have refractory major depression,PTSD, anxiety and sleep disorder. Not one day of my life is enjoyable. how long? Another 30 years?

Suicide is not the easy way out, believe me I've had 3 serious attempts, twice I was very close to being sucessful. Very angry to wake up in ICU. It goes against every natural instinct of human nature. So when a person gets to a point of making serious attempts and really wants to end their lives they are fighting human nature and its not a simple thing to do.

I can't believe that I am the only one out here with Refractory Depression, how do the rest of you deal with this? Or feel about it?

Years a decade now. bottled up . cannot understand how I have manage to survive until now. I am without any douby friends with death more than with those of life. Oh sure they say ittakes guts to live and its easy t commit suicide and suicide accomplishes nothing. The first may be true but the second most certainly is not. There is help out there... well no for many incl myself the help has only made things worse... I will accomplish the ceasation of suffering soon. For those of you will some doubt .. what can I say but follow up on it and seek pro help. It may help you get well. michael

When your son's wife goes through her delusional states, how do you deal with that. How does he cope and make the realationship work?. Its hard with kids and trying to help this person cope with their deprssion, nothing ever pleases them. their helplessness makes you feel helpless.

About feeling helpless - - Feb 27th 2008
I just read what someone wrote and I really wish I could personally help. My son's wife is undergoing a serious episode with depression. I have seen first-hand two of these in her. She gets delusional and thinks everybody wants to hurt her and she doesnt know why. She doesnt react in front of her children and the 2 year old is showing knowlwdge that something is wrong with disruptive behavior. NOw, I want to make something clear. God doesnt give anybody this to cope with. These are ideas that must be given up. How we react to life's stresses is our own business. Some can, others can not, but we are not left alone. People dwell on their vague thoughts and ideas about Jesus, and they dont go to a gospel preaching church and really explore the Word of God, You see, if you dont get serious about Jesus, you will always be the victim of yourself and your environment. Jesus is the Lord, and in Him you can overcome all things. Jesus is your empowerment over all that drains your joy. He is Life and Liberty over strife. he came to set the captives free. We are getting together to support and pray for Jennifer, and we have faith that she will overcome. Take your medications, go to therapy, and follow the Master's footsteps, seek Jesus. This may be the missing element in your recovery! God bless!

Fustrated with my label is Bipolar II, I can relate to insomia feelings of hopelessness, helplessness, can't sleep, can control my mood when I'm blue, most fustrating is sleep and tiredness, . But I have never had psycotic delusions or hallucinations with this, either did my Dad who was Bipolar I he had extreme mood swing from manic to really low. Mine seems to cycle with anxiety as more prevalent and anxiety over not being able to control my tiredness and mood and sleep. But never lost control over my behavior of spending, sex or dangerous risky behaviior. My only fear is living like this and continuing to have to live feeling this way. Ionly entertained wanting to end it because it seems like quality of life gets zapped away and drains all your energy just to cope. This is depressing no wonder wer feel socially rejected, noone wants to be around us either. Because it so DEPRESSING< and theere is'nt a dam thing they can do or you can do except hope that the pill the Dr gives you will work. and that is the only hope you have. And there is prayer if you believe but even that drains you. BEcause you wonder in the amidst of this Where is He why did he give you this to deal with??? I know my family rejected my Dad I did I hated his disease and now I hat e myself because I have it too in some milder form. I'm so scared to get my family triggered over this. I have a loving husband and I have that onw thing to be thankful, but that doe'snt mean I livei in constant worry if this will wear him out too? I just got a clear diagnosis this week, so this is al so frresh but expains my fatigue when all along i know I was suffering Chronic fatigue sydrome, with anxiety and depression overlaying this.