Current Psychiatry Reports

, Volume 12, Issue 6, pp 531–538 | Cite as

An Overview of Mood Disorders in the DSM-5

  • Jan Fawcett


The process of revising the DSM, which is based on new findings in the literature and experience with the current classification, is initiated every 12–18 years. The process for the revision of DSM-IV to the DSM-5 began in 2006—after a series of meeting proceedings and monographs were published during the previous 3 years—with the appointment of diagnostic group chairs by Director Dr. David Kupfer and Vice Director Dr. Darrel Regier. Members were recruited for workgroups to review the existing DSM-IV, to decide what worked well and which areas needed change, to review the available literature and data, and to propose changes based on an appropriate level of evidence in the literature proportional to the significance of the change. At the halfway point in this process, the Mood Disorders Workgroup has made tentative recommendations to be tested in field trials. These recommendations and some of the basis for them are discussed in this review. Final decisions await the data from field trials, possible revisions by the workgroups, and action by the task force. This article describes some of the recommendations made by the Mood Disorders Workgroup at this point in the process.


DSM-5 DSM-IV Major depressive episode Bipolar disorder Bipolar NOS Mixed specifier Mixed anxiety depression Suicide Anxiety Categorical diagnosis Dimensional diagnosis 



Dr. Fawcett has served on a board for Merck & Co.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Moreno C, Laje G, Blanco C, et al.: National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch gen Psychiatry 2007, 64:1032–1039.CrossRefPubMedGoogle Scholar
  2. 2.
    Spearing M, Post RM, Leverich GS, et al.: Modification of the Clinical Global Impression (CGI) scale for use in bipolar illness: the CGI-BP. Psychiatry Res 1997, 73:159–171.CrossRefPubMedGoogle Scholar
  3. 3.
    Kroenke K, Spitzer RL, Williams JB, Lowe B: The Patient Health Questionnaire, somatic, anxiety and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010, 32:345–359.CrossRefPubMedGoogle Scholar
  4. 4.
    Keller MB, Lavori PW, Friedman B, et al.: The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry 1987, 44:540–548.PubMedGoogle Scholar
  5. 5.
    Altman EG, Hedeker D, Peterson JL, Davis JM: The Altman Self-Rating Mania Scale. Biol Psychiatry 1997, 42:948–955.CrossRefPubMedGoogle Scholar
  6. 6.
    McKibbin C, Patterson T, Jeste DV: Assessing disability in older patients with schizophrenia: results from the WHODAS II. J Nerv Ment Dis 2004, 192:405–413.CrossRefPubMedGoogle Scholar
  7. 7.
    • Fava M, Rush AJ, Alpert JD, et al.: Difference in treatment outcome in patients with anxious vs non-anxious depression: a STAR*D report. Am J Psychiatry 2008, 165:342–351. This analysis of STAR*D outcome data in patients with major depression showed that patients with higher levels of anxiety had significantly poorer responses to antidepressant medications. CrossRefPubMedGoogle Scholar
  8. 8.
    Papakostas GI, McGrath P, Stewart J, et al.: Psychic and somatic anxiety as predictors of response to fluoxetine in major depressive disorder. Psychiatry Res 2008, 161:116–120.CrossRefPubMedGoogle Scholar
  9. 9.
    Howland RH, Rush AJ, Wisniewshi SR, et al.: Concurrent anxiety and substance abuse disorders among outpatients with major depression: clinical features and effect on treatment outcome. Drug Alcohol Depend 2009, 99:248–260.CrossRefPubMedGoogle Scholar
  10. 10.
    Yang H, Chuzi S, Sinicropi-Yao L, et al.: Type of residual symptom and risk of relapse during the continuation/maintenance phase treatment of major depressive disorder with the selective serotonin reuptake inhibitor fluoxetine. Eur Arch Psychiatry Clin Neurosci 2010, 260:145–150.CrossRefPubMedGoogle Scholar
  11. 11.
    Thase ME: Update of partial response in depression. J Clin Psychiatry 2009, 70(Suppl 6):4–9.CrossRefPubMedGoogle Scholar
  12. 12.
    • Coryell W, Soloman DA, Fiedorowicz JG, et al.: Anxiety and outcome in bipolar disorder. Am J Psychiatry 2009, 166:1238–1243. This analysis of the Collaborative Depression Study of bipolar patients showed that high psychic and somatic anxiety scores on the SADS-C scales at baseline are associated with a stepwise increase in time spent in a depressive episode over 5-year periods during a 20-year follow-up. CrossRefPubMedGoogle Scholar
  13. 13.
    Fawcett J, Scheftner WA, Fogg L, et al.: Time related predictors of suicide in major depressive disorder. Am J Psychiatry 1990, 147:1189–1194.PubMedGoogle Scholar
  14. 14.
    Busch KA, Fawcett J, Jacobs D: Clinical correlates of inpatient suicide. J Clin Psychiatry 2003, 64:14–19.CrossRefPubMedGoogle Scholar
  15. 15.
    Simon GE, Hunkeler E, Fireman B, et al.: Risk of suicide and suicide death in patients treated for bipolar disorder. Bipolar Disord 2007, 9:526–530.CrossRefPubMedGoogle Scholar
  16. 16.
    • Pfeiffer PN, Ganoczy D, Ligen M, et al.: Comorbid anxiety as a suicide risk factor among depressed veterans. Depress Anxiety 2009, 26:752–757. This follow-up study of more than 800,000 depressed veterans found significantly higher rates of suicide among patients with comorbid generalized anxiety disorder, panic disorder, and anxiety NOS disorder, but not in the case of other anxiety disorders, including post-traumatic stress disorder. Furthermore, patients receiving antianxiety treatment had elevated rates of suicide, and these rates were elevated further if the patient was receiving high-dose antianxiety medications, suggesting a relationship between anxiety severity and suicide risk. CrossRefPubMedGoogle Scholar
  17. 17.
    Clayton PJ, Grove WM, Coryell WM, et al.: Follow up and family study of anxious depression. Am J Psychiatry 1991, 148:1512–1517.PubMedGoogle Scholar
  18. 18.
    Oquendo MA, Malone KM, Ellis SP, et al.: Inadequacy of antidepressant treatment for patients with major depression who are at risk for suicidal behavior. Am J Psychiatry 1999, 156:190.PubMedGoogle Scholar
  19. 19.
    Harris EC, Barraclough B: Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997, 170:205–228.CrossRefPubMedGoogle Scholar
  20. 20.
    Coryell W, Young EA: Clinical predictors of suicide in primary major depressive disorder. J Clin Psychiatry 2005, 66:412–417.CrossRefPubMedGoogle Scholar
  21. 21.
    Oquendo M, Currier D, Mann JJ: Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors? Acta Psychiatr Scand 2006, 114:151–158.CrossRefPubMedGoogle Scholar
  22. 22.
    Marangell LB, Bauer MS, Dennehy EB, et al.: Prospective predictors of suicide and suicide attempts in 1,556 patients with bipolar disorders followed up to 2 years. Bipolar Disord 2006, 8:566–575.CrossRefPubMedGoogle Scholar
  23. 23.
    Baldessarini RJ, Hennen J: Genetics of suicide: an overview. Harv Rev Psychiatry 2004, 12:1–13.PubMedGoogle Scholar
  24. 24.
    Brent DS, Melham N: Familial transmission of suicidal behavior. Psychiatr Clin North Am 2008, 31:157–177.CrossRefPubMedGoogle Scholar
  25. 25.
    Sarrchiapone M, Carli V, Giannantonio MD, Roy A: Risk factors for attempting suicide in prisoners. Suicide Life Threat Behav 2009, 39:343–350.CrossRefGoogle Scholar
  26. 26.
    Roy A, Gorodelsky E, Yuan Q, et al.: Neuropsychopharmacology 2010, 35:1674–1683.PubMedGoogle Scholar
  27. 27.
    Isometsa ET, Lonnqyist JK: Suicide attempts preceding suicide. Br J Psychiatry 1998, 173:531–535.CrossRefPubMedGoogle Scholar
  28. 28.
    Isometsa ET, Heikkinen ME, Martunen MJ, et al.: The last appointment before suicide: is suicide intent communicated? Am J Psychiatry 1995, 152:919–922.PubMedGoogle Scholar
  29. 29.
    Sachs GS, Nierenberg AA, Calabrese JR, et al.: Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007, 356:1711–1722.CrossRefPubMedGoogle Scholar
  30. 30.
    Truman CJ, Goldberg JF, Ghaemi SN, et al.: Self-reported history of manic/hypomanic switch associated with antidepressant use: data from Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Clin Psychiatry 2007, 68:1472–1479.CrossRefPubMedGoogle Scholar
  31. 31.
    Holma KM, Melartin TK, Holma IA, Isometsa ET: Predictors for switch from unipolar major depressive disorder to bipolar disorder type I or II: a 5 year prospective study. J Clin Psychiatry 2008, 69:1267–1275.CrossRefPubMedGoogle Scholar
  32. 32.
    Ghaemi SN, Ostracher MM, El-Mallakh RS, et al.: Antidepressant discontinuation in bipolar depression: a Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) randomized clinical trial of long-term effectiveness and safety. J Clin Psychiatry 2010, 71:372–380.CrossRefPubMedGoogle Scholar
  33. 33.
    Goldberg JF, Perlis RH, Bowden CL, et al.: Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD. Am J Psychiatry 2009, 166:173–181.CrossRefPubMedGoogle Scholar
  34. 34.
    Calabrese JR, Muzina DJ, Kemp DE, et al.: Predictors of bipolar disorder risk among patients currently treated for major depression. MedGenMed 2006, 15:38.Google Scholar
  35. 35.
    Zimmermann P, Brucki T, Nocon A, et al.: Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity. Arch Gen Psychiatry 2009, 66:1341–1352.CrossRefPubMedGoogle Scholar
  36. 36.
    Agosti V, Stewart JW: Hypomania with and without dysphoria: comparison and clinical characteristics of respondents from a national community sample. J Affect Disord 2008, 108:177–182.CrossRefPubMedGoogle Scholar
  37. 37.
    Kendler KS, Myers J, Zisook S: Does bereavement-related major depression differ from major depression associated with other stressful life events? Am J Psychiatry 2008, 165:1449–1455.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of New Mexico School of MedicineAlbuquerqueUSA

Personalised recommendations