Major Depressive Episode

(Not a codable disorder)

A) Five (or more) of the following symptoms have been present during the same 2-week period oand represent a change from previous fnctioning; at least one of the sumptoms 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-incongruent delusions or hallucinations.

1 - depressed mood most of the day, nearly every day, as indicated by either subjective report (feels sad or empty) or observation made by others (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 (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 hypersomnia nearly every day

5 - psychomotor agitation or retardation nearly every day (observable by others, not mreely subjective feelings of restlessnes or being slowed down)

6 - fatigue or loss of energy nearly every day

7 - feelings of worthlessness or excessive or inappropriate guilt (whic 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 f death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for comitting 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 (a drug of abuse, a medication) or a general medical condition (hyperthyroidism).

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 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Manic Episode

(Not a codable disorder) 

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

B) During the period of mood disturbance, three (or more) or 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 (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 (attention too easily drawn to unimportant or irrelevant external stimuli)
6 - increase in goal-directed activity (either socially, at work or school, or sexually)
7 - excessive involvement in pleasurable activities that have a high potential for painful consequences (engagin in unrestrained buying spres, sexual indiscretions, or foolish business investments)

C) The symptoms do not meet criteria for a Mixed Episode.

D) 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 hospitalization to prevent harm to self or others, or there are psychotic features.

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

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder. 

Mixed Episode

(Not a codable disorder) 

A) The criteria are met both for a Manic Episode and for a Major Dpressive Episode (except for duration) nearly every day during at least a 1-week period.

B) 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 hospitalization to prevent harm to self or others, or there are psychotic features.

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

Note: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder. 

Hypomanic Episode

(Not a codable disorder) 

A) A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

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 ned for sleep (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 thougts are racing
5 - distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
6 - increase in goal-directed activity (either socially, ot work or school, or secually) or psychomotor agitation
7 - excessive involvement in pleasurable activities that have a high potential for painful consequenced (the person engages in unrestrained buying sprees, sexual indescretions, or foolish business investments)

C) The episode is associated with an unequivocal change in functioning that is uncharacteristic of ther person when not symptomatic.

D) The disturbance in mood and the change in functioning are observable by others.

E) The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F) The symptoms are not due to the directly physiological effects of a substances or a general medical condition (hyperthyroidism)

Note: Hypomanic-lke spisodes that are clearly caused by somatic antidepressant treatment (medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bopolar II Disorder. 

Major Depressive Disorder, Single Episode 

A) Presence of a single Major Depressive Episode

B) The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.

C) There has never been a Manic Episode, a Mixeed Episode, or a Hypomanic Episode.  Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition. 

If full criteria are currently met, spcifuy it scurrent clinical status and/or features:

Mild, Moderate, Severe Without Psychotic Features / Severe With Psychotic Features
Chronic
With Catatonic Features
Wth Melancolic Features
With Atypical Features
With Postpartum Onset

If the full criteria are not currently met, specify the current status of Disorder or features of the most recent episode:
In Partial Remission, In Full Remission
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset 

A) Presence of two or more Major Depressive Episodes

Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.

B) The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.

C) There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.  Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

If the full criteria are currently met, specify its current clinical status and/or features:

Mild, Moderate, Severe Without / With Psychotic Features
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset

If the full criteria are not currently met, specify the current clinical status of the Major Depressive Disorder of features of the most recent episode:

In Partial Remission, In Full Remission
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset

Specify:

Longitudinal Course Specifiers (with / without Interepisode Recovery)
With Seasonal Pattern 

A) Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

B) Presence, while depressed, of two (or more) of the following:

1 - poor appetite or overeating
2 - insomnia or hypersomnia
3 - low energy or fatigue
4 - low self-esteem
5 - poor conentration or difficulty making decisions
6 - feeling of hopelessness

C) During the 2-year period (1 year for children / adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.

D) No Major Depressive Episode has ben present during the first 2 years of the disrurbance (1 year - children/adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.

Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder.  In addition, after the initial 2 years (1 year - children/adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode. 

E) There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.

F) The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.

G) The symptoms are not due to the direct physiological effects of a substnace or a general medical condition.

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

Specify if:

Early Onset: if onset is before age 21
Late Onset: if onset is age 21 or older

Specify (with most recent 2 years) if:  With Atypical Features

Examples include:

1 - Premenstrual dysphoric disorder: in most menstrual cycles during the past year, symptoms regularly occurred during the last week of the luteal phase (and remitted within a few days of the onset of menses).  These symptoms must be severe enought to markedly interfere with work, school, or usual activities and be entirely absent for at least  week postmenses.

2 - Minor depressive disorder: episodes of at least 2 weeks of depressive symptoms but with fewer than the five items required for Major Depressive Disorder.

3 - Recurrent brief depressive disorder: depressive episodes lasting from 2 days up to 2 weeks, occurring at least once a month for 12 months (not associated with the menstrual cycal).

4 - Postpsychotic depressive disorder of Schizophrenia: a Major Depressive Episode that occurs during the residual phase of Schizophrenia.

5 - A Major Depressive Episode superimposed on Delusional Disorder, Psychotic Disorder NOS, or the active phase of Schizophrenia.

6 - Situations in which the clinician has concluded that a depressive disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced. 

A) Presence of only one Manic Episode and no past Majore Depressive Episodes.  Note: Recurrence is defined as either a change in polarity from depression or an interval of at least 2 months without manic symptoms.

B) The Manic Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS

Specify if: Mixed: if symptoms meet criteria for a Mized Episode

If the full criteria are currently met for a Manic, Mixed, or Major Depressive Eipsode (sic?)  specity its current clinical status and/or features:

Mild / Moderate / Severe Without/With Psychotic Features
With Catatonic Features
With Postpartum Onset

If the full criteria are not currently met for a Manic, Mixed, or Major Depressive Episode, specify the curent clinical status of the Bipolar I Disorder or features of the most recent episode:

In Partial Remission, In Full Remission
With Catatonic Features
With Postpartum Onset 

A) Currently (or most recently) in a Hypomanic Episode.

B) There has previously been at least one Manic Episode or Mixed Episode.

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

D) The mood iposides in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform DIsorder, Delusional Disorder, or Psychotic Disorder NOS.

Specify:

Longitudinal Course Specifiers (With / Without Interepisode Recovery)
With Seasonal Pattern
With Rapid Cycling

A) Currently (or most recently) in a Manic Episode.

B) There has previously been at least one Majore Depressive Episode, Manic Episode, or Mixed Episode.

C) The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.

If the full criteria are currently met for a Manic Episode, specify its current clinical status and/or features:

Mild, Moderate, Severe Without/With Psychotic Features
With Catatonic Features
With Postpartum Onset

If the full criteria are not currently met for a Manic Episode, specify the current clinical status of the Bipolar I Disorder and/or features of the most recent Manic Episode:

In Partial Remission, In Full Remission
With Catatonic Features
With Postpartum Onset

Specify:

Longitudinal Course Specifiers (With/without Interepisode Recovery)
With Seasonal Pattern
With Rapid Cycling 

A) Currently (or most recently) in a Mixed Episode

B) There has previously been at least one Majore Ddpressive Episode, Manic Episode, or Mixed Episode.

C) The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizohreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.

If the full criteria are currently met for a Mixed Episode, specify its current clinical status and/or features:

Mild, Moderate, Severe without/with Psychotic Features
With Catatonic Features
With Postpartum Onset

If the full criteria are not currently met for a Mixed Episode, specify the current clinical status of the Bipolar Disorder and/or features of the most recent Mixed Episode:

In Partial Remission, In Full Remission
With Catatonic Features
With Postpartum Onset

Specify:

Longitudinal Course Specifiers (with/without Interepisode Recovery)
With Seasonal Pattern
With Rapid Cycling 

A) Currently (or most recently) in a Major Depressive Episode.

B) There has previously been at least one Manic EPisode or Mixed Episode.

C) The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorer NOS.

If the full criteria are currently met for a Major Depressive Episode, specify its current clinical status and/or features:

Mild, Moderate, Severe Without/with Psychotic Features
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset

If the full criteria are not currently met for a Major Depressive Episode, specify the current clinical status of the Bipolar I Disorder and/or features of teh most recent Major Depressive Episode:

In Partial Remission, In Full Remission
Chronic
With Catatonic Features
With Melancholic Features
With Stypical Features
With Postpartm Onset

Specify:
Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern
With Rapid Cycling 

A) Criteria, except for duration, are currently (or most recently) met for a Manic, a Hypomanic, a Mixed, or a Major Depressive Episode.

B) There has previously been at least one Manic Episode or Mixed Episode.

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

D) The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.

E) The mood symptoms in Criteria A and B are not due to the direct physiological effects of a substance or a general medical condition.

Specify:

Longitudinal Course Specifiers (With/Without Interepisode Recovery)
With Seasonal Pattern
With Rapid Cycling 

A) Presence (or history) of one or more Major Depressive Episodes.

B) Presence (or history) of at least one Hyomanic Episode.

C) There has never been a Manic Episode or a Mixed Episode.

D) The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.

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

Specify current or most recent episode:  Hypomanic or Depressed

If the full criteria are currently met for a Major Depressive Episode, specify its current clinical status and/or features:

Mild, Moderate, Severe Without/With Psychotic Features
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset

If the full criteria are not currently met for a Hypomanic of Major Depressive Episode, specify the clinical status of the Bipolar II Disorder and/or features of the most recent Major Depressive Episode (only if it is the most recent episode).

Specify:

Longitudinal Course Specifiers (With/Without Interepisode Recovery)
With Seasonal Pattern
With Rapid Cycling 

A) For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: children/adolescents 1 year.

B) During the above 2-year period (child/adolescents 1 year), the person has not been without the symptoms in Criterion A for more than 2 months at a time.

C) No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance. Note: After the initial 2 years (children/adolescents 1 year) of Cyclothymic DIsorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).

D) The symptoms in Criterion  are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS. 

E) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

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

Examples include:

1 - Very rapid alternation (over days) between manic symptoms and depressive symptoms that meet symptom threshold criteria but not minimal duration criteria for Manic, Hypomanic, or Major Depressive Episodes

2 - Recurrnet Hypomanic Episodes without intercurrent depressive symptoms

3 - A Manic or Mixed Episode superimposed on Delusional Disorder, residual Schizophrenia, or Psychotic Disorder NOS 

4 - Hypomanic Episodes, along with chronic depressive symptoms, that are too infrequent to qualify for a diagnosis of Cyclothymic Disorder

5 - Situations in which the clinician has concluded that a Bipolar Disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced 

A) A prominent and persistent disturbance in mood predominates in the clinical picture and is charaterized by either (or both) of the following:

1 - depressed mood or markedly diminished interest or pleasure in all, or almost all, activities

2 - elevated, expansive, or irritable mood

B) There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition. 

C) The disturbance is not better accounted for by another mental disorder (Adjustment Disorder With Depressed Mood in response to the stress of having a general medical condition).

D) The disturbance does not occur exclusively during the course of a delirium.

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

Specify type:

With Depressive Features: if the predominant mood is depressed but the full criteria are not met for a Major Depressive Episode

With Major Depressive-Like Episode: if the full criteria are met (except Criterion D) for a Major Depressive Episode

With Manic Features: if the predominant mood is elevated, euphoric, or irritable

With Mixed Features: if the symptoms of both mania and depression are present but neither predominates 

A) A prominant and persistent disturbance in  mood predominates in the clinical picture and is characterized by either (or both) of the following:

1- depressed mood or markedly diminished interest or pleasure in all, or almost all, activities

2 - elevated, expansive, or irritable mood

B) There is evidence from the history, physical examination, or laboratory findings of either (1) or (2):

1 - the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal

2 - medication use is etiologically related to the disturbance 

C) The disturbance is not better accounted for by a Mood Disorder that is not substance induced.  Evidence that the symptoms are better accounted for by a Mood Disorder that is not substance induced might include teh following: the symptoms persist for a substantial period of time(about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Mood Disorder (history of recurrent MDE).

D) The disturbance does not occur exclusively during the course of a delirium.

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

Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the mood symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.

Code [Specific Substance]-Induced Mood Disorder

Specify type:

With Depressive Features: if the predominant mood is depressed

With Manic Features: if the predominant mood is elevated, euphoric, or irritable

With Mixed Features: if symptoms of both mania and depression are present and neither predominates

Specify if:
With Onset During Intoxication: if the criteria are met for Intoxication with the substance and the symptoms develop during the intoxication syndrome

With Onset During Withdrawal: if criteria are met for Withdrawal from the substance and the symptms develp during, or shortly after, a withdrawal syndrome 

Specify if:

Chronic (can be applied to the current or most recent Major Depressive Episode in Major Depressive Disorder and to a Major Depressive Episode in Bipolar I or II Disorder only if it is the most recent type  of mood episode)

Full criteria for a Major Depressive Episode have been met continuously for at least the past 2 years. 

Speicify if:

With Catatonic Features (can be applied to the current or most recent Major Depressive Episode, Manic Episode, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder, or Bipolar II Disorder)

The clinical picture is dominated by at least two of the following:

1 - motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor

2 - excessive motor activity (that is apparently purposeless and not influenced by external stimuli)

3 - extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism

4 - peculiaities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bixarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing

5 - echolalia or echopraxia 

Specify if:

With Melancholic Features (can be applied to the current or most recent Major Depressive Episode in Major Depressive Disorder and to a Major Depressive Episode in Bipolar I or Bipolar II Disorder only if it is the most recent type of mood episode)

A) Either of the following, occurring during the most severe period of the current episode:

1 - loss of pleasure in all, or almost all, activities

2 - lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)

B) Three (or more) of the following:

1 - distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)

2 - depression regularly worse in the morning

3 - early morning awakening (at least 2 hours before the usual time of awakening)

4 - marked psychomotor retardation or agitation

5 - significant anorexia or weight loss

6 - excessive or inappropriate guilt 

Specify if:

With Atypical Features (can be applied when these features predominate during the most recent 2 weeks of a current Major Depressive Episode in Major Depressive Disorder or in Bipolar I or Bipolar II Disorder when a current Major Depressive Episode is the most recent type of mood episode, or when these features predominate during the most recent 2 years of Dysthymic Disorder; if the Major Depressive Episode is not current, it applies if the feature predominates during any 2-week period) 

A) Mood reactivity (i.e. mood brightens in response to actual or potential positive events)

B) Two or more of the following features:

1 - significant weight gain or increase in appetite

2 - hypersomnia

3 - leaden paralysis (i.e., heavy, leaden feelings in arms or legs)

4 - long-standing pattern or interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment

C) Criteria are not met for With Melancholic Features or With Catatoni Features during the same episode. 

Postpartum Onset Specifier 

Specify if:

With Postpartum Onset (can be applied to the current or most recent Major Depressive, Manic, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder, or Bipolar II Disorder; or to Brief Psychotic Disorder)

Onset of episode within 4 weeks postpartum 

Specify if:

With Seasonal Pattern (can be applied to the pattern of Major Depressive Episodes in Bipolar I Disorder, Bipolar II Disorder, or Major Depressive Disorder, Recurret)

A) There has been a regular temporal relationship between the onset of Majore Depressive Episodes in Bipolar I or Bipolar II Disorder of Major Depressive Disorder, Recurrent, and a particular time of the year (e.g., regular appearance of the Major Depressive Episode in the fall or winter).

Note: Do not include cases in which there is an obvious efect of seasonal-related psychoocial stressors (regularly being unemployed every winter).

B) Full remissions (or a change from depression to mania or hypomania) also occur at a characteristic time of the year (depression disappears in the spring)

C) In the last 2 years, two Major Depressive Episodes have occurred that demonstrate the temporal seasonal relationships defined in Criteria A and B, and no nonseasonal Major Depressive Episodes have occurred during that same period.

D) Seasonal Major Depressive Episodes (as described above) substantially outnumber the nonseasonal Major Depressive Episodes that may have occurred over the individual's lifetime. 

Specify if:

With Rapid Cycling (can be applied to Bipoar I Disorder or Bipolar II Disorder)

At least four episodes of a mood disturbance in the previous 12 months that meet criteria for a Major Depressive, Manic, Mixed, or Hypomanic Episode.

Note: Episodes are demarcated either by partial or full remission for at least 2 months or a switch to an episode or opposite polarity (e.g., Major Depressive Episode to Manic Episode).