| A) At least one of the following three abnormal moods which significantly interfered with the person's life: 1.bnormal depressed mood most of the day, nearly every day, for at least 2 weeks. 2. Abnormal loss of all interest and pleasure most of the day, nearly every day, for at least 2 weeks. 3.If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least 2 weeks. B) At least five of the following symptoms have been present during the same 2 week depressed period. 1.Abnormal depressed mood (or irritable mood if a child or adolescent) [as defined in criterion A]. 2.Abnormal loss of all interest and pleasure [as defined in criterion A2]. 3.Appetite or weight disturbance, either: Abnormal weight loss (when not dieting) or decrease in appetite. Abnormal weight gain or increase in appetite. 4.Sleep disturbance, either abnormal insomnia or abnormal hypersomnia. 5.Activity disturbance, either abnormal agitation or abnormal slowing (observable by others). 6.Abnormal fatigue or loss of energy. 7.Abnormal self-reproach or inappropriate guilt. 8.Abnormal poor concentration or indecisiveness. 9.Abnormal morbid thoughts of death (not just fear of dying) or suicide. C) The symptoms are not due to a mood-incongruent psychosis. D) There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. E) The symptoms are not due to physical illness, alcohol, medication, or street drugs. F) The symptoms are not due to normal bereavement. |
| MAJOR DEPRESSIVE DISORDER |
| DSM-IV DIAGNOSTIC CRITERIA |
| ICD-10 DIAGNOSTIC CRITERIA |
| In typical depressive episodes of all three varieties described below (mild, moderate, and severe), the individual usually suffers from depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatiguability and diminished activity. Marked tiredness after only slight effort is common. Other common symptoms are: (a) reduced concentration and attention; (b) reduced self-esteem and self-confidence; (c) ideas of guilt and unworthiness (even in a mild type of episode); (d) bleak and pessimistic views of the future; (e) ideas or acts of self-harm or suicide; (f) disturbed sleep; (g) diminished appetite. The lowered mood varies little from day to day, and is often unresponsive to circumstances, yet may show a characteristic diurnal variation as the day goes on. As with manic episodes, the clinical presentation shows marked individual variations, and atypical presentations are particularly common in adolescence. In some cases, anxiety, distress, and motor agitation may be more prominent at times than the depression, and the mood change may also be masked by added features such as irritability, excessive consumption of alcohol, histrionic behaviour, and exacerbation of pre-existing phobic or obsessional symptoms, or by hypochondriacal preoccupations. For depressive episodes of all three grades of severity, a duration of at least 2 weeks is usually required for diagnosis, but shorter periods may be reasonable if symptoms are unusually severe and of rapid onset. Some of the above symptoms may be marked and develop characteristic features that are widely regarded as having special clinical significance. The most typical examples of these "somatic" symptoms are: loss of interest or pleasure in activities that are normally enjoyable; lack of emotional reactivity to normally pleasurable surroundings and events; waking in the morning 2 hours or more before the usual time; depression worse in the morning; objective evidence of definite psychomotor retardation or agitation (remarked on or reported by other people); marked loss of appetite; weight loss (often defined as 5% or more of body weight in the past month); marked loss of libido. Usually, this somatic syndrome is not regarded as present unless about four of these symptoms are definitely present. Acts of self-harm associated with mood (affective) disorders, most commonly self-poisoning by prescribed medication, should be recorded by means of an additional code from Chapter XX of ICD-10 (X60-X84). These codes do not involve differentiation between attempted suicide and "parasuicide", since both are included in the general category of self-harm. Differentiation between mild, moderate, and severe depressive episodes rests upon a complicated clinical judgement that involves the number, type, and severity of symptoms present. The extent of ordinary social and work activities is often a useful general guide to the likely degree of severity of the episode, but individual, social, and cultural influences that disrupt a smooth relationship between severity of symptoms and social performance are sufficiently common and powerful to make it unwise to include social performance amongst the essential criteria of severity. Includes: * single episodes of depression (without psychotic symptoms), psychogenic depression or reactive depression) |
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