Table 3-11 -- Criteria for Major Depressive Episode
A. Five (or more) of the following symptoms have been present during
the same 2-week period and represent a change from previous functioning;
at least one of the symptoms is either (1) depressed mood or (2) loss of
interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.
(1) depressed mood most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad or empty) or observation made
by others (e.g., appears tearful). Note: In children and adolescents,
can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by either
subjective account or observation made by others).
(3) significant weight loss when not dieting or weight gain (e.g., a
change of more than 5% of body weight in a month), or decrease or
increase in appetite nearly every day. Note: In children, consider
failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day.
(5) psychomotor agitation or retardation nearly every day (observable
by others, not merely subjective feelings of restlessness or being
slowed down).
(6) fatigue or loss of energy nearly every day.
(7) feelings of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely self-reproach or
guilt about being sick).
(8) diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by
others).
(9) recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide.
B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical
condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by Bereavement, i.e.,
after the loss of a loved one, the symptoms persist for longer than 2
months or are characterized by marked functional impairment, morbid
preoccupation with worthlessness, suicidal ideation, psychotic symptoms,
or psychomotor retardation.
SOURCE: American Psychiatric Association, DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th edition (Washington, DC: American Psychiatric Association, 1994).