Note: “Atypical depression” has historical significance (i.e., atypical in contradis- tinction to the more classical agitated, “endogenous" presentations of depression that were the norm when depression was rarely diagnosed in outpatients and al- common or unusual clinical 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. Increased appetite may be manifested by an obvious increase in food intake or by 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 time. Unlike the other atypical features, pathological sensitivity to perceived inter- personal 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 or hallucinations are present at any time in the episode. If psychotic features are present, specify if mood-congruent or mood-incon- gruent:
With mood-congruent psychotic features: During manic episodes, the con- tent of all delusions and hallucinations is consistent with the typical manic themes of grandiosity, invulnerability, etc., but may also include themes of sus- piciousness or paranoia, especially with respect to others' doubts about the in- dividual’s capacities, accomplishments, and so forth.
With mood-incongruent psychotic features: The content of delusions and hallucinations is inconsistent with the episode polarity themes as described above, or the content is a mixture of mood-incongruent and mood-congruent themes.
With catatonia: This specifier can apply to an episode of mania or depression if cata- tonic features are present during most of the episode. See criteria for catatonia asso- ciated with a mental disorder in the chapter “Schizophrenia Spectrum and Other
Psychotic Disorders.“
With peripartum onset: This specifier can be applied to the current or, if the full crite- ria are not currently met for a mood episode, most recent episode of mania, hypoma- nia, or major depression in bipolar | or bipolar II disorder if onset of mood symptoms occurs during pregnancy or in the 4 weeks following 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 featuresx 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.