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This relies on the skills of recognizing patterns of symptoms. It is not based on pathology, diagnostic tests or the presence or absence of an immediate cause. Neither does it suggest a particular treatment. In diagnosing depression both systems allow for somatic symptoms, psychotic symptoms and other illness characteristics, some of which ICD- specific criteria for a diagnosis. The advantage of using such systems is said to be that it has led to standardization of diagnostic practice across psychiatry and countries and allowed more accurate description of syndromes.

This could be due to increased pituitary adrenocorticotrophic hormone production, which in turn could be due to a disorder of hypothalamic control. Corticotrophin releasing hormone is known to be inhibited by noradrenaline and serotonin. However, a raised level of cortisol is also seen in mania and may just be a sign of a stressful condition. Pathological changes have been deduced from neuroimaging studies with computed tomography scans. Mood disorders are associated with changes in regional brain function, which is different to those seen in non-depressed patients who feel sad.

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