Table 1.

Diagnostic Criteria for Major Depressive Disorder

Major Depressive Episode
• Five or more of the following symptoms (present for at least 2 weeks):
        1. Depressed mood most of the day, nearly every day.
        2. Markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day.
        3. Significant weight loss or weight gain.
        4. Insomnia or hypersomnia nearly every day.
        5. Psychomotor retardation or agitation nearly every day.
        6. Fatigue or loss of energy nearly every day.
        7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
        8. Diminished ability to think or concentrate or indecisiveness nearly every day.
        9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt, or specific plan for committing suicide.
• Includes a change from previous functioning.
• At least one symptom is either depressed mood or loss of interest or pleasure.
• Note: Do not include symptoms due to a medical condition/mood incongruent delusions or hallucinations.
• Symptoms do not meet criteria for a Mixed Depressive Episode
• The symptoms cause clinically significant distress/impairment in social occupational, or other important areas of functioning.
• The symptoms are not due to a substance (drug abuse/medication) or general medical condition (eg, hypothyroidism).
• The symptoms are not better accounted for by bereavement.
Single Episode
• Presence of a single Major Depressive Episode.
• The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
• There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
    Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.
Recurrent
• Presence of two or more Major Depressive Episodes.
    Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
• The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
• There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
    Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

  • Reprinted from American Psychiatric Association: Diagnostic and statistical manual of mental disorders, 4th ed, text rev. Washington DC: American Psychiatric Publishing, Inc; 2000. p. 375–6. Copyright © 2000 American Psychiatric Association. Used with permission.