DSM-IV Diagnostic Criteria
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
(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
(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
(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-reproaching guilt about being
(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
B. The symptoms do not meet criteria for a Mixed Episode (both manic and
depressive symptoms at the same time)
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.,
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
A. A distinct period of abnormally and persistently elevated, expansive, or
irritable mood, lasting at least 1 week or requiring hospitalization.
B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have been
present to a significant degree.
(1) Inflated self-esteem or grandiosity.
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking,br>
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
(6) increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
(7) excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g. engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)
C. The symptoms do not meet criteria for a mixed episode (presence of symptoms
of major depression and mania at same time)
D. The mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationships with
others, or to necessitate hospitalization to prevent harm to self or others,
or there are psychotic features.
E. The symptoms are not do to a direct physiological effect of a substance
(e.g. a drug of abuse, a medication, or other treatment) or a general medical
condition (e.g., hyperthyroidism)
A. The criteria are met both for a Manic Episode and for a Major Depressive
Episode (except for duration) nearly every day during at least a 1 week
B. Same as criterion D for Manic Episode, above.
C. Same as criterion E for Manic Episode, above.
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