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 not include symptoms that are clearly attributable to another medical condition.
i. Depressed most of the day, nearly every day as indicated by subjective report
(e.g. feels sad, empty, hopeless) or observation made by others (e.g. appears
ii. Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by subjective account or observation)
iii.Significant weight loss when not dieting or weight gain (e.g. change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly
iv.Insomnia or hypersomnia nearly every day
v.Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down)
vi. Fatigue or loss of energy nearly every day
vii.Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
viii.Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others)
ix.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
The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to
another medical condition.
Note: The above criteria represent a major depressive episode.
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
There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance induced or are attributable to the physiological effects of another medical condition.