DSM-IV 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.

  • 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.
  • 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 mad by others)
  • 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.
  • insomnia or hypersomnia nearly
    every day
  • psychomotor agitation or retardation nearly
    every day (observable by others, no merely subjective feelings of
    restlessness or being slowed down)
  • fatigue or loss of
    energy nearly every day
  • feelings of worthlessness or
    excessive or inappropriate guilt (which may be delusional) nearly
    every day (not merely self-reproach or guilt about being sick)
  • diminished ability to think or concentrate, or indecisiveness,
    nearly every day (either by subjective account or as observed by others)
  • 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 long than 2 months or are characterized by marked
    functional impairment, morbid preoccupation with worthlessness,
    suicidal ideation, psychotic symptoms, or psychomotor retardation.

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