A. 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 two years. |
NOTE: In children and adolescents, mood can be irritable and duration must be at least one year. |
B. Presence, while depressed, of two (or more) of the following: |
1) Poor appetite or overeating. |
2) Insomnia or hypersomnia. |
3) Low energy or fatigue. |
4) Low self-esteem. |
5) Poor concentration or difficulty making decisions. |
6) Feelings of hopelessness. |
C. During the two-year period (one year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than two months at a time. |
D. Criteria for a major depressive disorder may be continuously present for two years. |
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. |
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. |
G. The symptoms are not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition (eg, hypothyroidism). |
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
NOTE: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than two years but will not meet criteria for persistent depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted. |
Specify if: |
With anxious distress |
With mixed features |
With melancholic features |
With atypical features |
With mood-congruent psychotic features |
With mood-incongruent psychotic features |
With peripartum onset |
Specify if: |
In partial remission |
In full remission |
Specify if: |
Early onset: If onset is before 21 years. |
Late onset: If onset is at age 21 years or older. |
Specify if (for most recent two years of persistant depressive disorder): |
With pure dysthymic syndrome: Full criteria for a major depressive episode have not been met in at least the preceding two years. |
With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding two-year period. |
With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least eight weeks in at least the preceding two years with symptoms below the threshold for a full major depressive episode. |
With intermittent major depressive episodes, without current episode: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding two years. |
Specify current severity: |
Mild |
Moderate |
Severe |
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