Major depressive episode is not a disorder in itself, but rather is a description of

part of a disorder, most often major depressive disorder or bipolar disorder. A

person who suffers from a major depressive episode must either have a depressed
mood or a loss of interest or pleasure in daily activities consistently for at least a 2
week period.
A major depressive episode is also characterized by the presence of 5 or more of
these symptoms:

Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feeling sad or empty) or observation made by others
(e.g., appears tearful). (In children and adolescents, this may be
characterized as an irritable mood.)
Markedly diminished interest or pleasure in all, or almost all, activities most
of the day, nearly every day
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.
Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every
day
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
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

A hypomanic episode is not a disorder in itself, but rather is a description of a part

of a type of bipolar II disorder. Hypomanic episodes have the same symptoms as
manic episodes with two important differences: (1) the mood usually isnt severe
enough to cause problems with the person working or socializing with others (e.g.,
they dont have to take time off work during the episode), or to require
hospitalization; and (2) there are never any psychotic features present in a
hypomanic episode.
A hypomanic episode is characterized by a distinct period of persistently
elevated, expansive, or irritable mood, lasting throughout at least 4 days and
present for most of the day nearly every day. This hypomanic mood is clearly
different from the persons usual mood.
During the period of mood disturbance, 3 or more of the following symptoms have
persisted (4 if the mood is only irritable) and have been present to a significant
degree:

Inflated self-esteem or grandiosity

Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Distractibility (e.g., attention too easily drawn to unimportant or irrelevant
external stimuli)
Increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
Excessive involvement in pleasurable activities that have a high potential for
painful consequences (e.g., the person engages in unrestrained buying
sprees, sexual indiscretions, or foolish business investments)

A hypomanic episode is associated with a change in functioning that is

uncharacteristic of the person. For example, the individual may be far more
productive or outgoing and socialable than they usually are. This change in
functioning and in mood is not subtle the change is directly noticeable by others
(usually friends or family members) during a hypomanic episode.

A Manic Episode must last at least 1 week (or less if hospitalization is required). It
is characterized by the presence of psychotic features. A manic episode is
characterized by period of at least 1 week where an elevated, expansive or
unusually irritable mood, as well as notably persistent goal-directed activity is
present. The mood disturbance associated with manic symptoms should be
observable by others (e.g., friends or relatives of the individual) and must be
uncharacteristic of the individuals usual state/behavior. These feelings must be
sufficiently severe to cause difficulty or impairment in occupational, social,
educational or other important functioning. A manic episode is characterized by
period of at least 1 week where an elevated, expansive or unusually irritable mood,
as well as notably persistent goal-directed activity is present.
A mixed episode is defined by meeting the diagnostic criteria for both a manic
episode as well as an episode nearly every day for at least a full week.
Major Depressive Disorder is a condition characterized by one or more Major
Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes. If
Manic, Mixed, or Hypomanic Episodes develop, the diagnosis is changed to Bipolar
Disorder. A Major Depressive Episode represents a decline from previous functioning
which has at least 5 of the following 9 symptoms: (1) depressed mood, (2) loss
of interest or pleasure, (3) significant change in appetite/weight, (4)
insomnia/hypersomnia, (5) psychomotor agitation/slowing, (6) fatigue/loss
of energy, (7) feelings of worthlessness/inappropriate guilt, (8) inability to
concentrate/indecisiveness, (9) recurrent thoughts of death/suicide.

Persistent Depressive Disorder, formerly known as Dysthymic Disorder

(also known as dysthymia), has been recently renamed in the updated DSM-5
(2013).
The essential feature of persistent depressive disorder (dysthymia) is a depressed
mood that occurs for most of the day, for more days than not, for at least 2
years (at least 1 year for children and adolescents).
Individuals with persistent depressive disorder describe their mood as sad or down
in the dumps. During periods of depressed mood, at least two of the following six
symptoms from are present.

Poor appetite or overeating

Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness

Furthermore, in order to be diagnosed with Persistent Depressive Disorder, there

has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode in the
first 2 years, and criteria have never been met for Cyclothymic Disorder. Dysthymia
is a milder yet more enduring type of depression that affects women two to three
times more often than men.

Double depression is a condition that occurs when an individual suffering from

mild depression falls into a major depressive state. New research identifies
hopelessness as a key feature of double depression. Double depression occurs when
an individual who suffers from dysthymia, a persistent case of mild depression
marked by low energy, falls into a major depressive state. They found that doubledepressed patients had high levels of hopelessness, whereas patients with either
major depression or dysthymia alone showed more moderate levels of
hopelessness.

Bipolar disorder, also known by its older name "manic depression," is a mental
disorder that is characterized by serious mood swings. A person with bipolar
disorder experiences alternating highs (what clinicians call mania) and lows
(also known as depression). Both the manic and depressive periods can be brief,
from just a few hours to a few days, or longer, lasting up to several weeks or even
months. The periods of mania and depression vary from person to person many
people may only experience very brief periods of these intense moods, and may not
even be aware that they have bipolar disorder.

Bipolar disorder is divided into several subtypes. Each has a different pattern of
symptoms. Types of bipolar disorder include:
Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your
job, school or relationships. Manic episodes can be severe and dangerous.
Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an
elevated mood, irritability and some changes in your functioning, but generally you
can carry on with your normal daily routine. Instead of full-blown mania, you have
hypomania a less severe form of mania. In bipolar II, periods of depression
typically last longer than periods of hypomania.
Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild
form of bipolar disorder. With cyclothymia, hypomania and depression can be
disruptive, but the highs and lows are not as severe as they are with other types of
bipolar disorder.
The exact symptoms of bipolar disorder vary from person to person. For some
people, depression causes the most problems; for other people, manic symptoms
are the main concern. Symptoms of depression and symptoms of mania or
hypomania may also occur together. This is known as a mixed episode.
Manic phase of bipolar disorder
Signs and symptoms of the manic or hypomanic phase of bipolar disorder can
include:

Euphoria
Inflated self-esteem
Poor judgment
Rapid speech
Racing thoughts
Aggressive behavior
Agitation or irritation
Increased physical activity
Risky behavior
Spending sprees or unwise financial choices
Increased drive to perform or achieve goals
Increased sex drive
Decreased need for sleep
Easily distracted
Careless or dangerous use of drugs or alcohol
Frequent absences from work or school
Delusions or a break from reality (psychosis)
Poor performance at work or school

Depressive phase of bipolar disorder

Signs and symptoms of the depressive phase of bipolar disorder can include:

Sadness
Hopelessness
Suicidal thoughts or behavior
Anxiety
Guilt
Sleep problems
Low appetite or increased appetite
Fatigue
Loss of interest in activities once considered enjoyable
Problems concentrating
Irritability
Chronic pain without a known cause
Frequent absences from work or school
Poor performance at work or school

"Permissive hypothesis", depression arises when low serotonin levels promote

low levels of norepinephrine, another monoamine neurotransmitter.