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The word "depression" provides an example of terminological difficulty. Among lay users the word is generally used to refer to a normal state of dejection. In a clinical setting it is used both to describe a symptom (as in "her mood appeared consistently depressed") and to label a syndrome (as in "severe depressive disorder"). Depression is common, as an isolated symptom and is one of the most common complaints presented to doctors and as a result its management forms a large part of medical, as well as psychiatric, practice particularly as depressive symptoms or syndromes often accompany physical ailments.
There is little difficulty in distinguishing severe cases of mania or major depression from normal mood states. However, when a mood disorder is milder it can be difficult to distinguish from a "normal" emotional response to circumstances.
In distinguishing a normal from a pathological mood state a clinician will make the following judgements:
- Whether the severity and duration exceed normal expectations.
- Whether the individuals ability to care for himself/herself has been impaired.
- Whether there are physical, psychomotor or cognitive changes that accompany the depressed or elevated mood.
Episodes of mood disorders may be of low mood (depressive episode), high mood (hypomanic or manic episode) or occasionally a mixture of high and low features (mixed affective state).
In both ICD-10 and DSM-IV recurrent episodes of hypomania/mania with or without depression are termed bipolar disorder.
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