Symptomatic and course presentations for mood episodes in mood disorders

Description

These categories may be applied to describe the presentation and characteristics of mood episodes in the context of single episode depressive disorder, recurrent depressive disorder, bipolar type I disorder, or bipolar type II disorder. These categories indicate the presence of specific, important features of the clinical presentation or of the course, onset, and pattern of mood episodes. These categories are not mutually exclusive, and as many may be added as apply. [1]

Diagnostic requirements

WHO clinical descriptions and diagnostic requirements [1,2].

Subcategories

• 6A80.0 Prominent anxiety symptoms in mood episodes

  In the context of a current depressive, manic, mixed, or hypomanic episode, prominent and clinically significant anxiety symptoms (e.g., feeling nervous, anxious or on edge, not being able to control worrying thoughts, fear that something awful will happen, having trouble relaxing, motor tension, autonomic symptoms) have been present for most of the time during the episode. If there have been panic attacks during a current depressive or mixed episode, these should be recorded separately. When the diagnostic requirements for both a mood disorder and an anxiety or fear-related disorder are met, the anxiety or fear-related disorder should also be diagnosed. [1]

  • This specifier can be applied if, in the context of a current Depressive, Manic, Mixed, or Hypomanic Episode, prominent and clinically significant anxiety symptoms (e.g., feeling nervous, anxious or on edge, not being able to control worrying thoughts, fear that something awful will happen, having trouble relaxing, muscle tension, autonomic symptoms) have been present for most of the time during the episode. If there have been panic attacks during the current Depressive or Mixed Episode, these should be recorded separately (see ‘with panic attacks’ specifier). This specifier may be used whether or not the diagnostic requirements for an Anxiety or Fear-Related Disorder are also met, in which case the Anxiety or Fear-Related Disorder should also be diagnosed.
• 6A80.1 Panic attacks in mood episodes

  In the context of a current mood episode (manic, depressive, mixed, or hypomanic), there have been recurrent panic attacks (i.e., at least two) during the past month that occur specifically in response to anxiety-provoking cognitions that are features of the mood episode. If panic attacks occur exclusively in response to such thoughts, panic attacks should be recorded using this qualifier rather than assigning an additional co-occurring diagnosis of panic disorder. If some panic attacks over the course of the depressive or mixed episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts, a separate diagnosis of panic disorder should be assigned. [1]

  • This specifier can be applied if, in the context of a current Episode, there have been panic attacks during the past month that occur specifically in response to depressive ruminations or other anxiety-provoking cognitions. If panic attacks occur exclusively in response to such thoughts, the ‘with panic attacks’ specifier should be applied rather than an additional co-occurring diagnosis of Panic Disorder. If some panic attacks over the course of the Depressive or Mixed Episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts and the full diagnostic requirements for Panic Disorder are met, a separate diagnosis of Panic Disorder should be assigned.
• 6A80.2 Current depressive episode persistent

  The diagnostic requirements for a depressive episode are currently met and have been met continuously for at least the past 2 years. [1]

  • This specifier can be applied if the diagnostic requirements for Depressive Episode are currently met and have been met continuously (five or more characteristic symptoms occurring most of the day, nearly every day) for at least the past 2 years.
• 6A80.3 Current depressive episode with melancholia

  In the context of a current Depressive Episode, several of the following symptoms have been present during the worst period of the current episode: loss of interest or pleasure in most activities that are normally enjoyable to the individual (i.e., pervasive anhedonia); lack of emotional reactivity to normally pleasurable stimuli or circumstances (i.e., mood does not lift even transiently with exposure); terminal insomnia (i.e., waking in the morning two hours or more before the usual time); depressive symptoms are worse in the morning; marked psychomotor retardation or agitation; marked loss of appetite or loss of weight. [1]

  • This specifier can be applied if, in the context of a current Depressive Episode, several of the following symptoms have been present during the worst period of the current episode:
    • Loss of interest or pleasure in most activities that are normally enjoyable to the individual (i.e., pervasive anhedonia).
    • Lack of emotional reactivity to normally pleasurable stimuli or circumstances (i.e., mood does not lift even transiently with exposure).
    • Terminal insomnia (i.e., waking in the morning 2 hours or more before the usual time).
    • Depressive symptoms are worse in the morning.
    • Marked psychomotor retardation or agitation.
    • Marked loss of appetite or loss of weight.
• 6A80.4 Seasonal pattern of mood episode onset

  In the context of recurrent depressive disorder, bipolar type I or bipolar type II disorder, there has been a regular seasonal pattern of onset and remission of at least one type of episode (i.e., depressive, manic, mixed, or hypomanic episodes), with a substantial majority of the relevant mood episodes corresponding to the seasonal pattern. (In bipolar type I and bipolar type II disorder, all types of mood episodes may not follow this pattern.) A seasonal pattern should be differentiated from an episode that is coincidental with a particular season but predominantly related to a psychological stressor that regularly occurs at that time of the year (e.g., seasonal unemployment). [1]

  • This specifier can be applied if:
    • In the context of Bipolar Type I or Bipolar Type II Disorder there has been a regular seasonal pattern of onset and remission of at least one type of episode (i.e., Depressive, Manic, Mixed, or Hypomanic Episodes); the other types of Mood Episodes may not follow this pattern; or
    • In the context of Recurrent Depressive Disorder there has been a regular seasonal pattern of onset and remission of Depressive Episodes.
  • A substantial majority of the relevant Mood Episodes should correspond with the seasonal pattern.
  • A seasonal pattern should be differentiated from an episode that is coincidental with a particular season but predominantly related to a psychological stressor that regularly occurs at that time of the year (e.g., seasonal unemployment).
• 6A80.5 Rapid cycling

  In the context of bipolar type I or bipolar type II disorder, there has been a high frequency of mood episodes (at least four) over the past 12 months. There may be a switch from one polarity of mood to the other, or the mood episodes may be demarcated by a period of remission. In individuals with a high frequency of mood episodes, some may have a shorter duration than those usually observed in bipolar type I or bipolar type II disorder. In particular, depressive periods may only last several days. If depressive and manic symptoms alternate very rapidly (i.e., from day to day or within the same day), a mixed episode should be diagnosed rather than rapid cycling. [1]

  • This specifier can be applied if the Bipolar Type I or Bipolar Type II Disorder is characterized by a high frequency of Mood Episodes (at least four) over the past 12 months. There may be a switch from one polarity of mood to the other, or the Mood Episodes may be demarcated by a period of remission.
  • In individuals with a high frequency of Mood Episodes, some may have a shorter duration than those usually observed in Bipolar Type I or Bipolar Type II Disorder. In particular, depressive periods may only last several days. However, if depressive and manic symptoms alternate very rapidly (i.e., from day to day or within the same day), a Mixed Episode should be diagnosed rather than rapid cycling.

References

1. World Health Organization. International Classification of Diseases, 11th Revision, for Mortality and Morbidity Statistics (ICD-11 MMS), 2026-01 release. World Health Organization; 2026.
2. World Health Organization. Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders (CDDR). World Health Organization; 2024.

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