| (A) 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 () depressed mood or () loss of interest or pleasure. |
| Note: Do not include symptoms that are clearly attributable to another medical condition. |
| () Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) |
| or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.) |
| () 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 observation). |
| () Significant weight loss when not dieting or weight gain (e.g., 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 gain.) |
| () Insomnia or hypersomnia nearly every day. |
| () Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness |
| or being slowed down). |
| () Fatigue or loss of energy nearly every day. |
| () Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely |
| self-reproach or guilt about being sick). |
| () Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed |
| by others). |
| () 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. |
| (B) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of |
| functioning. |
| (C) The episode is not attributable to the physiological effects of a substance or to another medical condition. |
| Note: Criteria A–C represent a major depressive episode. |
| Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness |
| or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss |
| noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered |
| appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should |
| also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history |
| and the cultural norms for the expression of distress in the context of loss. |
| (D) 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 psychotic |
| disorders. |
| (E) 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 |
