Major depressive disorder represents the classic condition in this group of disorders that involve clear-cut changes in affect, cognition, and neurovegetative state. Careful consideration
is given to the differentiation of normal sadness and grief from a major depressive episode.
Bereavement may induce great suffering, but it does not typically induce an episode
of major depressive disorder.
A. Five (or more) of the following symptoms (not attributable to another medical condition) have been present during the same 2-week period and represent a change from previous functioning:
1. Depressed mood most of the day, nearly every day (feels sad, empty, hopeless, tearful) — in children and adolescents, can be an irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss (when not dieting) or weight gain (a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day — in children, failure to make expected weight gain.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day.
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.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
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 cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
See reference for more information.
Adapted from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC. American Psychiatric Association. 2013. Internet. Accessed on March 21, 2020. p. 160.