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The evaluation of a patient with a suspected mood disorder begins with a physical examination by a physician. Medical conditions and side effects of medications must be ruled out as potential causes of symptoms.

A physical examination is followed by a mental health evaluation by a physician or a mental health professional. This evaluation includes a complete history of symptoms, including when they started, how long they have lasted and how severe they are. It is also noted whether the patient has experienced these symptoms before and, if so, whether and how they were treated. The physician or mental health professional will also ask about alcohol and drug use, whether the patient has thought about death or suicide and whether other family members have had a mood disorder. If there is a history of a mood disorder in any family members, their treatment and its effectiveness will be discussed.  

Despite being serious and common disorders, mood disorders are highly underdiagnosed for many reasons. Some people believe there is a stigma attached to seeking help for any potential mental health condition. Mood disorders may be overlooked in pregnancy and medical conditions with similar symptoms. Diagnosis in adolescents may be difficult because many adults may expect moodiness in teens. Children may be difficult to diagnose because of confusion with attention deficit hyperactivity disorder (ADHD), which may also exist alongside mood disorders. ADHD and mood disorders must be identified separately because they require different treatment.

Mood disorders are not diagnosed if certain other mental illnesses, particularly ongoing substance abuse or psychotic disorders (e.g., schizophrenia, schizoaffective disorder), are present.

When major depressive episodes occur in patients with no history of manic, hypomanic or mixed episodes, major depression may be diagnosed. The diagnosis of an episode of major depression requires that symptoms must be severe enough to cause distress or impairment in function and last for two weeks or longer. The patient must experience at least five key symptoms. One of these five symptoms must be altered mood or loss of interest in pleasurable activities (anhedonia). The other key symptoms include:

• Substantial change in appetite or weight
• Too little or too much sleep
• Observable agitation or sluggishness in activity
• Fatigue
• Reduced feelings of self-worth
• Problems with concentration
• Thoughts about death or suicide

If a manic or mixed episode ever occurs, bipolar I disorder is diagnosed. The diagnosis of a manic episode requires symptoms that are severe enough to impair function in occupational performance or social relationships. If the mood is elevated, three or more key symptoms must be present. If the mood is irritable, four or more symptoms must occur. All symptoms must last for one week or longer. The key symptoms of mania include:

• Uncharacteristically elevated self-esteem or feelings of grandiosity
  
  
• Decreased need for sleep
  
  
• Talking more than usual or feeling a need to keep talking
  
  
• “Flight of ideas” or feeling as though thoughts are racing
  
  
• Distractibility
  
  
• Increased goal-directed activity
  
  
• Seeking pleasure without regard to consequences, reckless behavior or poor judgment (e.g., spending sprees, sexual promiscuity, substance abuse)

Mixed episodes fulfill the symptom-based criteria for both manic and depressive episodes, but must last a minimum of only one week. During these episodes, the patient often cycles rapidly between manic and depressive symptoms.

When hypomanic episodes occur in patients with a history of at least one major depressive episode but no history of manic or mixed episodes, bipolar II disorder is diagnosed. The criteria for a diagnosis of a hypomanic episode are the same as for a manic episode, except that they symptoms need only occur for a minimum of four days and a change in function, not necessarily an impairment, must be present. The symptoms must be observable to others, not necessarily the patient.

If depression that lasts for two or more years and does not meet the criteria for a major depressive episode occurs in a patient with no history of manic, mixed or hypomanic episode, dysthymia is diagnosed. When rapid mood swings and hypomania occur along with a similar low-grade, chronic depression, cyclothymia is diagnosed.

For postpartum depression (PPD), the symptoms of depression must begin within four weeks of childbirth. For seasonal affective disorder (SAD), the symptoms must begin during the same season each year (frequently, the onset of winter) and must not be attributable to another cause. For example, a worker who is unemployed each winter may be stressed by unemployment, not seasonal affective disorder.