Mood Disorders
Major Depressive Episode
The "Associated Laboratory Findings" section of the text was updated and expanded to include additional neurobiological abnormalities (e.g., alterations in neuropeptides and other hormones in response to challenge tests) and functional brain imaging results. The "Specific Gender Features" section was updated to clarify that increased risk in women emerges during adolescence and may coincide with puberty.
Major Depressive Disorder
Associated General Medical Conditions text was updated to emphasize that comorbid general medical conditions worsen the course of Major Depressive Disorder. The "Specific Age Features" section was expanded to include information about laboratory findings (e.g., evidence of subcortical white matter hyperintensities) in late-onset depression. Changes in the "Familial Pattern" section indicate increased risk of Anxiety Disorders in offspring of those with depression.
Dysthymic Disorder
The "Course" section was updated to indicate that the outcome of Dysthymic Disorder is significantly better with active treatment. Changes to Familial Pattern indicate elevated rates of both Dysthymic Disorder and Major Depressive Disorder in relatives of those with Dysthymic Disorder.
Bipolar I and Bipolar II Disorder
The "Associated Mental Disorders" section was expanded to include information on the comorbidity of Bipolar I Disorder and Alcohol and other Substance Use Disorders. Associated Laboratory Findings were updated to reflect increased rates of certain brain lesions in individuals with Bipolar I Disorder as a group. The "Associated General Medical Conditions" section was expanded to clarify the relationship between Bipolar I and Bipolar II Disorder and thyroid dysfunction (i.e., association between hypofunction and rapid cycling, and hyperthyroidism precipitating episodes in those with pre-existing Mood Disorder). Specific Gender Features were updated to reflect gender differences in Rapid Cycling, types of episodes, and risk for mixed episodes. The relationship between age at onset and family history was noted in Familial Pattern of Bipolar I Disorder.
Bipolar Disorder Not Otherwise Specified (NOS)
An additional example was added to clarify that individuals with chronic dysthymia who also experience occasional hypomanic episodes do not qualify for a diagnosis of either Dysthymic Disorder (because of the hypomanic episodes) or Cyclothymic Disorder (because the hypomanic episodes are too infrequent).
Catatonic Features
The text was expanded to provide a breakdown of the causes of catatonia.
Melancholic Features
The original statement that individuals with Melancholic Features are more likely to respond to somatic treatment was incorrect and was replaced by text that emphasizes the need for active treatment given the low placebo response rate.
Postpartum Onset
The "Associated Features" section was updated and text was added to highlight the differentiation of this subtype from “baby blues.”
Rapid Cycling
Updated text included prevalence data and the potential association between cycling rate and antidepressant therapy.