Criteria for Major
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.
The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
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).
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.