A diagnosis of “unspecified depressive disorder” is used when symptoms of depression cause significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any of the depressive disorder diagnoses. This diagnosis may be used with any of the following groups of symptoms:

• With anxious distress, defined as at least 2 of the following symptoms during the majority of days of a major depressive episode or dysthymia:
  o Feeling keyed up or tense
  o Feeling unusually restless
  o Difficulty concentrating because of worry
  o Fear that something awful may happen
  o Feeling that the individual may lose control of himself or herself
  
• With manic/hypomanic symptoms, when at least 3 of the following symptoms are present nearly every day during a major depressive episode and are not attributable to the effects of a substance (a drug of abuse, medication, or other treatment):
  o Elevated, expansive mood
  o Inflated self-esteem or grandiosity
  o More talkative than usual or pressure to keep talking
  o Flight of ideas or racing ideas
  o Increase in energy or goal-directed activity
  o Increased or excessive involvement in activities that have a high potential for painful consequences, such as engaging in unrestrained buying sprees, sexual indiscretions, foolish business investments.
  o Decreased need for sleep (feeling rested despite sleeping less than usual)
  
• With melancholic features, when one of the following is present during the most severe period of the depressive episode:
  o Loss of pleasure in all, or almost all, activities
  o Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)
  
  In addition, 3 or more of the following symptoms are present:
  o A depressed mood characterized by profound despondency, despair, or a so-called empty mood
  o Depression that is regularly worse in the morning
  o Early-morning awakening, at least 2 hours before usual wakening
  o Significant anorexia or weight loss
  o Excessive or inappropriate guilt
  
• Atypical symptoms may qualify for a diagnosis of depressive disorder when an individual experiences the following features during the majority of days:
  o Mood brightens in response to positive events
  o Two or more of the following:
  • Significant weight gain or increase in appetite
  • Hypersomnia (excessive sleeping)
  • Heavy, leaden feelings in arms or legs
  • Long-standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment
    
• Other features that may characterize a diagnosis for the unspecified depressive disorder include:
  o Delusions and/or hallucinations
  o Catatonia (abnormal movement and behavior arising from a disturbed mental state, typically schizophrenia)
  o Peripartum onset, if the most recent episode of major depression occurs during pregnancy or in the 4 weeks following delivery
  o Postpartum depression, which may occur with or without psychotic features
  o Seasonal patterns, when major depressive episodes occur during a particular time of the year, such as fall or winter