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Table 3. Diagnostic Criteria for a Major Depressive Episode

Table 3. Diagnostic Criteria for a Major Depressive Episode

A. Five (or more) of the following symptoms have been present nearly every day during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure:

1) Depressed mood^a most of the day as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)

2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day (as indicated by either subjective account or observation made by others)

3) Significant weight loss when not dieting,^b weight gain (e.g., a change of more than 5% of body weight in a month), or a decrease or increase in appetite

4) Insomnia or hypersomnia

5) Psychomotor agitation or retardation (observable by others, not merely subjective feelings of restlessness or being slowed down)

6) Fatigue or loss of energy

7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)^c

8) Diminished ability to think or concentrate or indecisiveness (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 previous 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) and have persisted for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Source. Adapted from DSM-IV-TR; mood-incongruent delusions, hallucinations, and symptoms that are clearly due to a general medical condition should not count toward a diagnosis of major depressive disorder.
^aIn children and adolescents, mood can also be irritable.
^bIn children, can also include failure to make expected weight gains.
^cSymptoms extend beyond mere self-reproach or guilt about being sick.