Major depressive disorder. If there is a depressed mood plus two or more symptoms meeting criteria for a persistent depressive episode for 2 years or more, then the diagnosis of persistent depressive disorder is made. The diagnosis depends on the 2—year duration, which distinguishes it from episodes of depression that do not last 2 years. If the symptom criteria are sufficient for a diagnosis of a major depressive episode at any time during this pe- riod, then the diagnosis of major depression should be noted, but it is coded not as a separate diagnosis but rather as a specifier with the diagnosis of persistent depressive disorder. If the individual’s symptoms currently meet full criteria for a major depressive episode, then the specifier of "with intermittent major depressive episodes, with current episode” would be made. If the major depressive episode has persisted for at least a 2—year duration and re— mains present, then the specifier ”with persistent major depressive episode” is used. When full major depressive episode criteria are not currently met but there has been at least one previous episode of major depression in the context of at least 2 years of persistent depres- sive symptoms, then the specifier of ”with intermittent major depressive episodes, without current episode" is used. If the individual has not experienced an episode of major depres- sion in the last 2 years, then the specifier "with pure dysthymic syndrome" is used.
Psychotic disorders. Depressive symptoms are a common associated feature of chronic psychotic disorders (e.g., schizoaffective disorder, schizophrenia, delusional disorder). A separate diagnosis of persistent depressive disorder is not made if the symptoms occur only during the course of the psychotic disorder (including residual phases).
Depressive or bipolar and related disorder due to another medical condition. Persistent order due to another medical condition. The diagnosis is depressive or bipolar and related disorder due to another medical condition if the mood disturbance is judged, based on his- tory, physical examination, or laboratory findings, to be attributable to the direct patho- physiological effects of a specific, usually chronic, medical condition (e.g., multiple sclerosis). If it is judged that the depressive symptoms are not attributable to the physiolog- ical effects of another medical condition, then the primary mental disorder (e.g., persistent depressive disorder) is recorded, and the medical condition is noted as a concomitant med- ical condition (e.g., diabetes mellitus).
Substance/medication-induced depressive or bipolar disorder. A substance/medi— cation-induced depressive or bipolar and related disorder is distinguished from persis- tent depressive disorder when a substance (e.g., a drug of abuse, a medication, a toxin) is judged to be etiologically related to the mood disturbance.
Personality disorders. Often, there is evidence of a coexisting personality disturbance.
When an individual’s presentation meets the criteria for both persistent depressive disor- der and a personality disorder, both diagnoses are given.
In comparison to individuals with major depressive disorder, those with persistent de- pressive disorder are at higher risk for psychiatric comorbidity in general, and for anxiety disorders and substance use disorders in particular. Early-onset persistent depressive dis- order is strongly associated with DSM-IV Cluster B and C personality disorders.
Diagnostic Criteria 625.4 (N94.3)
A. In the majority of menstrual cycles. at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present: 1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or in- creased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.