4. A Iong-standing pattern of interpersonal rejection sensitivity (not limited to epi- sodes of mood disturbance) that results in significant social or occupational im- pairment.
C. Criteria are not met for “with melancholic features" or “with catatonia” during the same episode.
Note: “Atypical depression” has historical significance (i.e., atypical in contradistinction to the more classical agitated, “endogenous" presentations of depression that were the ical presentation as the term might imply.
Mood reactivity is the capacity to be cheered up when presented with positive events (e.g., a visit from children, compliments from others). Mood may become euthymic (not sad) even for extended periods of time if the external circumstances remain favorable.
weight gain. Hypersomnia may include either an extended period of nighttime sleep or daytime napping that totals at least 10 hours of sleep per day (or at least 2 hours more than when not depressed). Leaden paralysis is defined as feeling heavy, leaden, or weighted down, usually in the arms or legs. This sensation is generally present for at least an hour a day but often lasts for many hours at a time. Unlike the other atypical features, pathological sensitivity to perceived interpersonal rejection is a trait that has an early onset and persists throughout most of adult life. Rejection sensitivity occurs both when the person is and is not depressed, though it may be exacerbated during depressive periods.
With psychotic features: Delusions and/or hallucinations are present.
With mood-congruent psychotic features: The content of all delusions and hal- lucinations is consistent with the typical depressive themes of personal inade- quacy, guilt, disease, death, nihilism. or deserved punishment.
With mood-incongruent psychotic features: The content of the delusions or hal- lucinations does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment, or the content is a mixture of mood-incongruent and mood-congruent themes.
With catatonia: The catatonia specifier can apply to an episode of depression if cata- tonic features are present during most of the episode. See criteria for catatonia asso- ciated with a mental disorder (for a description of catatonia, see the chapter “Schizophrenia Spectrum and Other Psychotic Disorders").
With peripartum onset: This specifier can be applied to the current or, it full criteria are not currently met for a major depressive episode, most recent episode of major de- pression if onset of mood symptoms occurs during pregnancy or in the 4 weeks follow- ing delivery.
Note: Mood episodes can have their onset either during pregnancy or postpartum.
Although the estimates differ according to the period of Iollow-up after delivery, be- tween 3% and 6% of women will experience the onset of a major depressive epi- sode during pregnancy or in the weeks or months following delivery. Fifty percent of “postpartum" major depressive episodes actually begin prior to delivery. Thus, these episodes are referred to collectively as peripartum episodes. Women with attacks. Prospective studies have demonstrated that mood and anxiety symptoms during pregnancy, as well as the “baby blues," increase the risk for a postpartum major depressive episode.
Peripartum-onset mood episodes can present either with or without psychotic features. Infanticide is most often associated with postpartum psychotic episodes that are characterized by command hallucinations to kill the infant or delusions that the infant is possessed, but psychotic symptoms can also occur in severe postpar- tum mood episodes without such specific delusions or hallucinations.