Mood Disorders (Depression: http://www.allaboutdepression.com/dia_11.html)
The depressive disorders that are described on this web site are grouped under a category in the DSM-IV called Mood Disorders. Included in this category are major depressive disorder, dysthymic disorder, bipolar disorder, cyclothymic disorder, mood disorder due to a general medical condition, and substance-induced mood disorder. Two subtypes of mood disorders include seasonal affective disorder and postpartum depression, while premenstrual dysphoric disorder has been proposed as a diagnosis for further study. For each of these mood disorders there are specific criteria that a person's symptoms must meet in order to receive a diagnosis. 
Diagnosis of Major Depressive Disorder, Single Episode

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

A. The person experiences a single major depressive episode: 
1.	For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest. 
a.	Depressed mood. For children and adolescents, this may be irritable mood. 
b.	A significantly reduced level of interest or pleasure in most or all activities. 
c.	A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight. 
d.	Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia). 
e.	Behavior that is agitated or slowed down. Others should be able to observe this. 
f.	Feeling fatigued, or diminished energy. 
g.	Thoughts of worthlessness or extreme guilt (not about being ill). 
h.	Ability to think, concentrate, or make decisions is reduced. 
i.	Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide. 
2.	The persons' symptoms do not indicate a mixed episode. 
3.	The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. 
4.	The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder. 
5.	The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation). 

B. Another disorder does not better explain the major depressive episode.

C. The person has never had a manic, mixed, or a hypomanic Episode (unless an episode was due to a medical disorder or use of a substance). 	

Possible specifiers to describe the episode:
Severity: mild, moderate, severe without psychotic features
Severe With Psychotic Features
In Partial/Full Remission
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset

Major Depressive Disorder, Recurrent:
All of the above criteria apply, except with regard to criteria A there have been two or more major depressive episodes with at least two months in between in which no major depressive episode was present.

The above specifiers also apply with the addition of:
Longitudinal Course
With Seasonal Pattern

Dysthymic Disorder 
People with dysthymia generally experience little or no joy in their lives. Instead things are rather gloomy most of the time. If you have dysthymia you may be unable to remember a time when you felt happy, excited, or inspired. It may seem as if you have been depressed all your life. You probably have a hard time enjoying things and having fun. Rather, you might tend to be inactive and withdrawn , you worry frequently, and criticize yourself as being a failure. You may also feel guilty, irritable, sluggish, and have difficulty sleeping regularly.
Dysthymia is a milder yet more enduring type of depression that affects women two to three times more often than men. The diagnosis is given when a person has had continuous depressed mood for at least two years. For children, the duration only needs to be one year, and their mood may be irritable rather than sad or depressed. People with dysthymia may appear to be chronically mildly depressed to the point that it seems to be a part of their personality. When a person finally seeks treatment for dysthymia, it is not uncommon that he/she has had this condition for a number of years. Because dysthymia may develop early in a person's life, it is not uncommon for someone with this condition to believe that it is normal to always feel depressed. They often to do realize that the quality of their mood is anything out of the ordinary. This illness often goes unnoticed and, therefore, untreated.
Dysthymia is a condition that tends to develop early in a person's life, but most people delay approximately ten years before every seeking treatment. This is unfortunate since the sooner a person seeks help the sooner he or she can get relief and possibly avoid further distress. It is very important that children with symptoms of dysthymia receive an evaluation from a mental health professional or physician. Early treatment may help these youngsters avoid more serious mood disorders, difficulties in school and their social life, and possible substance abuse problems as they get older.
At any point in time, 3% of the population may be affected by dysthymia. Within a lifetime it appears to affect approximately 6%. Those with immediate relatives who have had major depressive disorder have a greater likelihood of developing dysthymia. If a person develops dysthymia it usually happens early in their lives- from childhood to early adulthood. The symptoms of dysthymia tend to be chronic, yet people often do not seek treatment unless they develop major depression. Having dysthymic disorder increases the risk of developing major depressive disorder. Of those with dysthymia approximately 10% will go on to develop major depression. The presence of both conditions is sometimes known as "double depression."
Dysthymia may also be associated with the presence of personality disorders (e.g., avoidant, dependent, histrionic, borderline, narcissistic). However, it can sometimes be difficult to determine the extent to which a personality disorder is present since some of the long-term problems of dysthymia may affect interpersonal relationships as well as how a person perceives him- or herself. Dysthymia may also be related to substance use. People with this type of chronic depression may abuse drugs or alcohol in trying to relieve their despondency and other unpleasant symptoms. Dysthymia in children may sometimes be related to anxiety disorders, learning disorders, attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and mental retardation. Physical illnesses that may be associated with dysthymia include acquired immunodeficiency syndrome (AIDS), hypothyroidism, and multiple sclerosis. 

Diagnosis of Dysthymic Disorder

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

A. A person has depressed mood for most the time almost every day for at least two years. Children and adolescents may have irritable mood, and the time frame is at least one year.

B. While depressed, a person experiences at least two of the following symptoms: 
1.	Either overeating or lack of appetite. 
2.	Sleeping to much or having difficulty sleeping. 
3.	Fatigue, lack of energy. 
4.	Poor self-esteem. 
5.	Difficulty with concentration or decision making. 
6.	Feeling hopeless. 

C. A person has not been free of the symptoms during the two-year time period (one-year for children and adolescents).

D. During the two-year time period (one-year for children and adolescents) there has not been a major depressive episode.

E. A person has not had a manic, mixed, or hypomanic episode.

F. The symptoms are not present only during the presence of another chronic disorder.

G. A medical condition or the use of substances (i.e., alcohol, drugs, medication, toxins) do not cause the symptoms.

H. The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. 	

Possible specifiers to describe dysthymia:
Early Onset: Dysthymic symptoms begin before the age of 21. This may increase the likelihood of developing later major depressive episodes.
Late Onset: Dysthymic symptoms begin after the age of 21.
With Atypical Features: Describes symptoms experienced during the last two years
(Show descriptions of "specifiers" in a new browser window)

Bipolar Disorder (Diagnostic Criteria: Bipolar I, Bipolar II)
Also known as manic-depression or manic-depressive disorder. This condition is characterized by mood that alternates between two emotional extremes, or poles: the sadness of depression and the euphoria of mania (see symptoms of mania below). Between these emotional swings, there are periods when a person's mood is quite normal. When a person is in the depressed phase of bipolar illness, he or she will have the same symptoms as those found in major depressive disorder. The depressive episodes can often be severe. While in a manic phase, a person experiences mood that is extremely elevated, expansive, or irritable. Mania can seriously impair one's normal judgment. When manic, a person is prone towards reckless and inappropriate behavior such as engaging in wild spending sprees or having promiscuous sex. He or she may not be able to realize the harm of his/her behavior and may even lose touch with reality.
There are two types of bipolar disorder:
Bipolar I Disorder is diagnosed when a person has had at least one manic or mixed episode, often along with a major depressive episode. It affects equal numbers of men and women in approximately 0.4% to 1.6% of the population.

Bipolar II Disorder is diagnosed when a person has had a major depressive episode along with at least one hypomanic episode. It affects more women than men in about 0.5% of the population. 
People with bipolar disorder experience a wide range of feelings depending on the phase of the illness is present. During a phase of depression, a person will have many of the symptoms of a major depressive episode. He or she may have despondent mood, a loss of energy, feelings of worthlessness or guilt, or problems with concentration. Thoughts of suicide are not uncommon. In fact, 10% to 15% of those with bipolar disorder may die by suicide. If the depression is severe, a person may need to be hospitalized for his or her own safety. For those who go through a phase of hypomania, the experience usually feels quite good. A person's mood and spirit lightens, he or she will be more outgoing and notice more energy and enhanced self-esteem. Lots of ideas come with ease and a person may feel compelled towards greater activity and productivity. A person in a hypomanic phase may also feel more powerful and omnipotent. 
The manic phase is the most extreme part of bipolar disorder. A person becomes euphoric, ideas come much too fast, and concentration is nearly impossible. Anger, irritability, fear, and a sense of being out of control are overwhelming. A person's judgment is impaired, and he or she may behave recklessly without a sense of consequence. Some people lose touch with reality and experience delusions and hallucinations. When this happens, people often need to be hospitalized for their own safety. If a person with bipolar disorder experiences a severe manic episode, he or she may be abusive to children, spouses, or engage in other violent behaviors. There may also be problems with attendance and performance at school or work, as well as significant difficulties in personal relationships.
The cycles of bipolar disorder may be different for each person. Oftentimes a person may first experience depression. Then depression may be replaced with manic symptoms and the cycle between depression and mania may continue for days, weeks, or months. Between phases of depression and mania some people return to their normal mood. Some others have several periods of either depression or mania. Still others may experience several bouts of depression with infrequent phases of hypomania, or repeated manic episodes with occasional depressive periods. A portion of people, roughly 10% to 20% may only experience mania, while others can have both depression and mania at the same time.
For at least 90% of those who have bipolar disorder the condition is recurrent. They will experience future symptoms of the cycles of mania and depression. Approximately 60%-70% of manic episodes may happen just before or after a depressive episode, and this pattern may happen in a particular way for each person. Most people return to a regular level of functioning between episodes, while some (about 20%-30%) may continue to have some problems with mood stability and social and occupational functioning.
Bipolar I disorder affects equal numbers of males and females, however there does appear to be a gender difference in the onset of the illness. Females are more likely to experience a first episode of depression, while males tend to have a first episode that is manic. Women who have bipolar I or II disorder and who have children may be at a higher risk of experiencing bipolar episodes within several months of giving birth. 
A first episode of mania is most likely to occur when a person is in his/her teens or twenties. If a person develops bipolar disorder for the first time after 40 years of age, he or she should be evaluated for the possibility of a medical illness or substance use.
People who have immediate relatives with bipolar I disorder have a higher risk of developing a mood disorder themselves. For these people the rate of developing bipolar II disorder or major depression is 4%-24% and bipolar I disorder is 1%-5%.
Of adolescents who have recurrent major depressive episodes, about 10%-15% of them will likely develop bipolar disorder.

Diagnosis of Bipolar I Disorder

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

A. A person experiences a current or recent episode that is manic, hypomanic, mixed, or depressed. 
1.	To be a manic episode, for at least one week a person's mood must be out of the ordinary and continuously heightened, exaggerated, or irritable. 
2.	At least three of the following seven symptoms have been significant and enduring. If the mood is only irritable, then four symptoms are required. 
a.	Self-esteem is excessive or grandiose. 
b.	The need for sleep is greatly reduced. 
c.	Talks much more than usual. 
d.	Thoughts and ideas are continuous and without a pattern or focus. 
e.	Easily distracted by unimportant things. 
f.	An increase in purposeful activity or productivity, or behaving and feeling agitated. 
g.	Reckless participation in enjoyable activities that create a high risk for negative consequences (e.g., extensive spending sprees, sexual promiscuity). 
3.	The persons' symptoms do not indicate a mixed episode. 
4.	The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. Or, the symptoms require the person to be hospitalized to protect the person from harming himself/herself or others. Or, the symptoms include psychotic features (hallucinations, delusions). 
5.	The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder. 

B. Unless this is a first single manic episode there has been at least one manic, mixed, hypomanic, or depressive episode.
1.	For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest. 
a.	Depressed mood. For children and adolescents, this may be irritable mood. 
b.	A significantly reduced level of interest or pleasure in most or all activities. 
c.	A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight. 
d.	Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia). 
e.	Behavior that is agitated or slowed down. Others should be able to observe this. 
f.	Feeling fatigued, or diminished energy. 
g.	Thoughts of worthlessness or extreme guilt (not about being ill). 
h.	Ability to think, concentrate, or make decisions is reduced. 
i.	Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide. 
2.	The persons' symptoms do not indicate a mixed episode. 
3.	The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. 
4.	The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder. 
5.	The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation). 

C. Another disorder does not better explain the episode. 	

Many of the specifiers used to describe mood disorders may be applicable for Bipolar I disorder.

Diagnosis of Bipolar II Disorder

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

A. The person currently has, or in the past has had at least one major depressive episode: 
1.	For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest. 
a.	Depressed mood. For children and adolescents, this may be irritable mood. 
b.	A significantly reduced level of interest or pleasure in most or all activities. 
c.	A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight. 
d.	Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia). 
e.	Behavior that is agitated or slowed down. Others should be able to observe this. 
f.	Feeling fatigued, or diminished energy. 
g.	Thoughts of worthlessness or extreme guilt (not about being ill). 
h.	Ability to think, concentrate, or make decisions is reduced. 
i.	Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide. 
2.	The persons' symptoms do not indicate a mixed episode. 
3.	The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. 
4.	The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder. 
5.	The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation). 

B. The person currently has, or in the past has had at least one hypomanic episode: 
1.	For a hypomanic episode a person's mood must be out of the ordinary and continuously heightened, exaggerated, or irritable for at least four days. 
2.	At least three of the following seven symptoms have been significant and enduring. If the mood is only irritable, then four symptoms are required. 
a.	Self-esteem is excessive or grandiose. 
b.	The need for sleep is greatly reduced. 
c.	Talks much more than usual. 
d.	Thoughts and ideas are continuous and without a pattern or focus. 
e.	Easily distracted by unimportant things. 
f.	An increase in purposeful activity or productivity, or behaving and feeling agitated. 
g.	Reckless participation in enjoyable activities that create a high risk for negative consequences (e.g., extensive spending sprees, sexual promiscuity). 
3.	The episode is a substantial change for the person and uncharacteristic of his or her usual functioning. 
4.	The changes of functioning and mood can be observed by others. 
5.	The person's symptoms are NOT severe enough to cause difficulty in functioning at home, work, or other important areas. Also, the symptoms neither require the person to be hospitalized, nor are there any psychotic features. 
6.	The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder. C. The person has never experienced a manic or mixed episode. D. Another disorder does not better explain the episode. E. The symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. 	

Many of the specifiers used to describe mood disorders may be applicable for Bipolar II disorder.

Cyclothymic Disorder 
A milder yet more enduring type of bipolar disorder. For at least two years a person will have experienced many periods of hypomanic symptoms (but not quite a manic episode), alternating with many periods of depressive symptoms (but not quite a major depressive episode). Essentially, a person's mood alternates between a less severe mania (known as hypomania) and a less severe depression.
Cyclothymia appears to affect equal numbers of men and women. It typically begins when a person is an adolescent or young adult and the condition tends to be chronic. There is a risk of 15%-50% that a person with cyclothymia will eventually develop bipolar disorder.
Diagnosis of Cyclothymic Disorder

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

A. A person has experienced many periods of depressive symptoms (not a full depressive episode), and periods of hypomanic symptoms for a minimum of two years. For children and adolescents, the time frame is a minimum of one year.

B. The person has not been free of the hypomanic or depressive symptoms for more than two months at a time.

C. Throughout the first two years of the illness the person has not had a manic, mixed, or major depressive episode.

D. Another disorder does not better explain the episode.

E. The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

F. The symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.	

Mood Disorder Due to a General Medical Condition (Diagnostic Criteria)
In order to receive this diagnosis, a mental health professional or physician must first determine that a general medical condition is present. This, of course, may already be established if a person with a medical disorder seeks treatment for problems with his or her mood.
Having clinical depression is not a normal part of coping with a medical condition. In fact, the presence of clinical depression can complicate a person's recovery from a medical condition. One problem is that having a mood disorder along with a serious medical condition can increase the risk of a person attempting and completing suicide. The greatest risk of suicide is related to the more chronic, painful, and incurable illnesses such as spinal cord injury, head injury, AIDS, malignant cancer, etc.
Diagnosis of Mood Disorder Due to a General Medical Condition

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

A. A person has significant disturbance in mood that includes either (or both): 
1.	Depressed mood or significantly reduced level of interest or pleasure in most or all activities. 
2.	Mood that is euphoric, heightened, or irritable. 
B. The person's symptoms are directly related to the presence of a medical condition.

C. Another disorder does not better explain the mood disturbance.

D. The mood condition is not present only when a person is delerious.

E. The symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.	

Possible specifiers used to describe the mood:
With Depressive Features: A person has depressed mood, but his/her symptoms are not enough to meet criteria for a major depressive episode.
With Major Depressive-Like Episode: A person's depressive symptoms meet criteria for a major depressive episode.
With Manic Features: A person's symptoms are primarily euphoric, heightened, or irritable.
With Mixed Features: A person has symptoms that are both depressive and manic and neither are dominant.

Substance-Induced Mood Disorder 
Depression may be caused or precipitated by the use or abuse of substances such as drugs, alcohol, medications, or exposure to toxins. A mental health professional or physician must determine whether the mood disorder occurs as a result of the substance or just happens to occur at the same time by coincidence. If it develops as a result of the use of or exposure to the substance then this diagnosis may be appropriate. To make a diagnosis of a substance-induced mood disorder, the disturbance can only occur while a person is intoxicated, going through withdrawal, or within four weeks of either.
Diagnosis of Substance-Induced Mood Disorder

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

A. A person has significant disturbance in mood that includes either (or both): 
1.	Depressed mood or significantly reduced level of interest or pleasure in most or all activities. 
2.	Mood that is euphoric, heightened, or irritable. 

B. The person's symptoms develop during (or within four weeks of) intoxication or withdrawal, or are caused by medication use.

C. Another disorder does not better explain the mood disturbance.

D. The mood condition is not present only when a person is delerious.

E. The symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.	

Possible specifiers used to describe the mood:
With Depressive Features: A person has depressed mood, but his/her symptoms are not enough to meet criteria for a major depressive episode.
With Manic Features: A person's symptoms are primarily euphoric, heightened, or irritable.
With Mixed Features: A person has symptoms that are both depressive and manic and neither are dominant.
With Onset During Intoxication: The symptoms develop while the person is intoxicated.
With Onset During Withdrawal: The symptoms develop while the person is in withdrawal.

Two subtypes of mood disorders include seasonal affective disorder and postpartum depression, while premenstrual dysphoric disorder has been proposed as a diagnosis for further study. For each of these mood disorders there are specific criteria that a person's symptoms must meet in order to receive a diagnosis.

Seasonal Affective Disorder (SAD) 
In terms of diagnosis, seasonal affective disorder is not really a separate mood disorder from major depression or bipolar disorder. Instead, "seasonal pattern" is a specifier used as additional diagnostic information to describe the regular pattern of the depressive episode associated with major depression or bipolar disorder. For instance, a person could receive the following diagnosis:
Major Depressive Disorder, Recurrent Episode, Moderate, With Seasonal Pattern
However, since people often refer to this type of depression as "Seasonal Affective Disorder" or "SAD" we will use that terminology here. SAD is a condition that affects a person during specific times or seasons of the year. Typically the depressive symptoms of this condition begin during fall or winter, and end when spring arrives. At other months during the year a person's mood will be normal, or at least will not meet criteria for clinical depression.
Those who have SAD may notice that in the winter months they have a lack of energy or feel sluggish, they sleep more than usual, they overeat and gain weight, and they may have a craving for carbohydrates. Of those who have SAD, 60%-90% are women. Rates of SAD are higher in those who live at higher latitudes. It also occurs more frequently in younger people and often begins in a person's twenties.
Diagnosis of a Seasonal Pattern Specifier

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

This specifier may describe the depressive episode in major depression or bipolar disorder.

A. A person has experienced a regular pattern of depressive episodes that begin at specific time of the year (e.g., fall or winter), and which are not related to specific yearly stressors such as school/college or seasonal unemployment.

B. The depression also ends or changes at a specific time of the year (e.g., spring).

C. The pattern has occurred for the most recent two years with no other symptoms outside of the pattern.

D. A person has had more seasonal depressions than non-seasonal depressions in his/her lifetime.	

Postpartum Depression
Postpartum depression is not really a separate mood disorder from major depression or bipolar disorder. The word, "postpartum" is a specifier used as additional diagnostic information to describe the onset or occurrence of the depressive episode associated with major depression or bipolar disorder. For instance, a person could receive the following diagnosis:
Major Depressive Disorder, Single Episode, Moderate, With Postpartum Onset
"With Postpartum Onset" describes an uncommon depressive episode that begins within four weeks of giving birth to a child and may affect up to 10% of new mothers. It is very different than the "baby blues" that women can experience usually 3-7 days after delivery. Many women with postpartum depression may experience great anxiety, panic attacks, spontaneous crying, difficulty sleeping, and a lack of interest in their new child. A woman's mood may fluctuate and seem inconsistent, and there may even be the presence of psychotic features (delusions, hallucinations). If this is the case, a woman should receive immediate medical attention and hospitalization may be necessary. Whether or not psychotic features are present, a woman may have suicidal thoughts, continuous thoughts about violence towards her child, a difficulty with concentration, and she may feel and appear to be quite agitated.
With regard to psychotic features, if a woman experiences delusions they may be about the child. For instance, a woman may believe that her child is evil, that he/she is doomed somehow, or that he/she is gifted with magical powers. Although a woman may harm or even kill her child when she is not experiencing psychotic symptoms, it tends to be more common when a psychosis is present. She may hear voices telling her to kill the child, or may harm the child as a result of certain delusions or beliefs about the child.
Psychotic symptoms may occur in 1in 500-1000 births and may be more frequent in women who have given birth for the first time. If a woman experiences a postpartum depression with psychotic features, her risk of developing it again with future deliveries may be between 30% and 50%. For those who have already had postpartum depression, their risk of a second episode with psychotic features is higher. The risk is also higher for those who previously have had a mood disorder.
Many women are frequently reluctant to tell anyone about their negative or depressive thoughts and feelings. They often feel quite guilty about them since they believe that having a new child is a time when they should feel very happy. Postpartum depression is a condition that is very treatable. Leaving it untreated can sometimes affect the quality of bonding and relationship between a mother and her child. 
Premenstrual Dysphoric Disorder 
Premenstrual dysphoric disorder is not an official disorder, but it has been proposed as a condition that needs further study. Information about this condition and the diagnostic criteria for research purposes is provided in an appendix of the DSM-IV. This means that researchers are encouraged to study this condition further so that more can be learned about it. In time researchers may accumulate enough evidence to support this condition as a valid diagnosis.
However, this condition is an uncommon type of depression affecting roughly 3% to 5% of menstruating women. It is a cyclical condition in which women may feel depressed and irritable for one or two weeks before their menstrual period each month. The symptoms disappear within a week or so of the beginning of her menstrual period.
Research Criteria for Premenstrual Dysphoric Disorder

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition 

A. During most of her menstrual cycles for the past year, a woman has experienced at least five of the following symptoms for most of the time one week before, and possibly during menstruation. The symptoms were not present approximately one week after menstruation, and at least one of the symptoms was 1-4.
1.	Substantially depressed mood, feeling hopeless, or negative thoughts about oneself. 
2.	Increased anxiety or agitation. 
3.	Sudden changes in mood or greater emotional sensitivity. 
4.	Increased anger or irritability, or more frequent conflicts in relationships. 
5.	A loss of interest in regular activities. 
6.	Problems with concentration. 
7.	Being easily tired, loss of energy. 
8.	A substantial change in appetite, overeating, or cravings for certain foods. 
9.	Getting too little sleep (insomnia) or too much sleep (hypersomnia). 
10.	A sense of being out of control or overwhelmed. 
11.	Physical symptoms including headaches, bloating, weight gain, swelling or tenderness of the breasts, pain in muscles or joints.
B. The person's symptoms cause difficulty within relationships, social activities, work, school, etc.

C. The symptoms are not just the result of a complication of another mental health condition.

D. The above criteria must be validated by daily recordings made during a minimum of two consecutive menstrual cycles in which the symptoms are present.