DSM-IV Criteria for Major Depressive Disorder |
1. 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. |
Note: Do note include symptoms that are clearly
due to a general medical condition or mood-incongruent delusions
or hallucinations. |
a. Depressed mood most of the day, nearly every
day, as indicated by either subjective report (eg, feels sad or
empty) or observation made by others (eg, appears tearful). Note: In
children and adolescents, can be irritable mood. |
b. 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 by observation
made by others) |
c. Significant weight loss when not dieting
or weight gain (eg, 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. |
d. Insomnia or hypersomnia nearly every day |
e. Psychomotor agitation or retardation nearly
every day (observable by others, not merely subjective feelings
of restlessness or being slowed down) |
f. Fatigue or loss of energy nearly every day |
g. Feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional) nearly every day (not
merely self-reproach or guilt about being sick) |
h. Diminished ability to think or concentrate,
or indecisiveness, nearly every day (either by subjective account
or as observed by others) |
i. 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 |
2. The symptoms do not meet criteria for a mixed episode. |
3. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning. |
4. The symptoms are not due to the direct physiological effects
of a substance (eg, a drug of abuse, a medication) or a general
medical condition (eg, hypothyroidism). |
5. The symptoms are not better accounted for by bereavement
(ie, 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). |
DSM-IV Criteria for Dysthymia |
1. Depressed mood for most of the day, for more days than
not, as indicated either by subjective account or observation by
others, for at least 2 years. In children and adolescents, mood
can be irritable and duration must be at least 1 year. |
2. Presence, while depressed, of two or more of the following: |
a. Poor appetite or overeating |
b. Insomnia or hypersomnia |
c. Low energy or fatigue |
d. Low self-esteem |
e. Poor concentration or difficulty making decisions |
f. Feelings of hopelessness |
3. During the 2-year period (or 1-year period for children
and adolescents) of the disturbance, the person has never been without
the symptoms in Criteria a and b for more than 2 months
at a time. |
4. No major depressive episode has been present during the
first 2 years of the disturbance (1 year for children and adolescents). |
5. There has never been a manic episode or a hypomanic episode,
and criteria have never been met for cyclothymic disorder. |
6. The disturbance does not occur exclusively during the
course of a chronic psychotic disorder (eg, schizophrenia or delusional
disorder). |
7. The symptoms are not due to the direct physiological effects
of a substance (eg, drug abuse, medication) or a general medical
condition (eg, hypothyroidism). |
8. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning. |
DSM-IV Criteria for a Manic Episode |
1. A distinct period of abnormally and persistently elevated,
expansive, or irritable mood, lasting at least 1 week (or any duration
if hospitalization is necessary). |
2. 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: |
a. Inflated self-esteem or grandiosity |
b. Decreased need for sleep (eg, feels rested
after only 3 hours of sleep) |
c. More talkative than usual or pressure to
keep talking |
d. Flight of ideas or subjective experience
that thoughts are racing |
e. Distractibility (ie, attention too easily
drawn to unimportant or irrelevant external stimuli) |
f. Increase in goal-directed activity (either
socially, at work or school, or sexually) or psychomotor agitation |
g. Excessive involvement in pleasurable activities
that have a high potential for painful consequences (eg, engaging
in unrestrained buying sprees, sexual indiscretions, or foolish
business investments) |
3. The symptoms do not meet criteria for a mixed episode. |
4. 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. |
5. The symptoms are not due to the direct physiological effects
of a substance (eg, a drug of abuse, a medication, or other treatment)
or a general medical condition (eg, hyperthyroidism). |
DSM-IV Criteria for a Mixed Episode |
1. 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 period. |
2. 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. |
3. The symptoms are not due to the direct physiological effects
of a substance (eg, a drug of abuse, a medication, or other treatment)
or a general medical condition (eg, hyperthyroidism). |