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| Depressive episode according to ICD-10 | Major depressive disorder according to DSM-IV-TR |
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| Generally, the patient should present for at least 2 weeks with the following. | (1) At least one of the two main symptoms and five or more of the additional symptoms present during the same 2-week period |
| (a) Main symptoms | (a) Main symptoms |
| (i) Lowering of mood | (i) Depressed mood |
| (ii) Reduction of energy | (ii) Loss of interest or pleasure |
| (iii) Decrease in activity | (b) Additional symptoms |
| (b) Additional symptoms | Fatigue or loss of energy |
| (i) Reduced capacity for enjoyment, interest and concentration | Decreased ability to think or concentrate, indecisiveness |
| (ii) Marked tiredness after even minimum effort | Insomnia or hypersomnia |
| (iii) Disturbed sleep | Feelings of worthlessness or excessive, inappropriate guilt |
| (iv) Diminished appetite | Recurrent thoughts of death or recurrent suicidal ideation |
| (v) Reduced self-esteem and self-confidence | Psychomotor agitation or retardation |
| (vi) Ideas of guilt or worthlessness | Significant weight loss or weight gain |
(c) Somatic symptoms
(i) Loss of interest and pleasurable feelings
(ii) Waking in the morning several hours before the usual time
(iii) Depression is worst in the morning
(iv) Marked psychomotor retardation, agitation
(v) Loss of appetite
(vi) Weight loss
(vii) Loss of libido | (2) Symptoms do not meet the criteria for a mixed episode
(3) Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas
(4) Symptoms are not due to direct physiological effects of a substance (i.e., drug or medication abuse) or medical condition (i.e., hypothyroidism)
(5) Symptoms are not better accounted for by a bereavement (e.g., after the loss of a loved one); they persist for more than 2 months or are characterized by marked functional imparment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. |
| Mild depressive episode: | |
| Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities | |
| Moderate depressive episode: | |
| Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities. | |
| Severe depressive episode without psychotic symptoms: | |
| An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. | |
| Suicidal thoughts and acts are common and a number of “somatic” symptoms are usually present. | |
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