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Bernard McDowell, lcsw

Psychotherapy & Couples Counseling  
2700 SE 26th Avenue Suite D, Portland, Oregon
503-234-9904


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Depression According To The Diagnostic and Statistical Manual

    Below is a list of the symptoms for "major depression" as set forth by a book called the "Diagnostic and Statistical Manual" [DSM-IV].  The DSM was insisted upon by virtually the entire insurance industry in the U.S. and its use has even been written into some laws.  However, the book has received much criticism from many respected researchers, intellectuals, and psychologists.  In fact, a handful of studies that have been done on the DSM prior to 2000 have utterly failed to demonstrate that professionals give the same diagnoses to similar clients casting doubt on whether the diagnostic categories are valid; further, other studies founds the DSM did not help to guide treatment.  In May 2012 the DSM-5, latest edition was published by the American Psychiatric Association; it underwent enormous criticism from many sides delaying it's publication for years. Just a year or so after, the National Institute of Mental Health [NIMH] disavowed the DSM as a basis for continuing research because of it's lack of scientific basis.  To further confuse the matter, new laws require the use of a different diagnostic format, the "ICD-10" originally designed for application to physical ailments; but that's just a matter of coding The DSM's version of depression is offered here only because of it's widespread use.  This list is given here as part of a broader discussion in another article on this site--"General Considerations About Depression".     The list of criteria below don't constitute the full criteria for any one diagnosis but are used as the basis for most depressive categories; also note that no other depressive diagnostic category spells out symptoms in as great detail. 
 
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.

      (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.