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DSM-IV Criteria for Major Depressive Episode

A. Five or more of the symptoms listed below 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.

 (1) Depressed mood most of the day nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observations of others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

 (2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day, as indicated by subjective account or observations of others.

(3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% body weight in one month or decrease or increase in appetite nearly every day. Note: In children, failure to achieve expected weight gains.

(4) Insomnia or hypersomnia nearly every day.

(5) Psychomotor agitation or retardation nearly every day, as indicated not merely by subjective feelings of restlessness or being slowed down but by observations of others. (6) Fatigue or loss of energy nearly every day.

(7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day, as indicated not merely by self-reproach or guilt about being sick.

(8) Diminished ability to think or concentrate or indecisiveness nearly every day, as indicated either by subjective account or observa- tions of others.

(9) 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 do not meet criteria for a mixed episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., an abused drug, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement (i.e., after the loss of a loved one) or the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation

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