Note.' A "Major Depressive
Syndrome" is defined as criterion A below.
A. At least five of the following
symptoms have been present dunng the same two-week period and represent a change
from previous functioning; as least one of the symptoms is either (1) depressed
mood, or (2) loss of interest or pleasure. (Do not Include symptoms that are
clearly due to a physicaJ condi-tion, mood-incongruent delusions or
hallucinations, incoherence. or marked loosening of associations.)
(1) depressed mood (or can be
irritable mood in children and adolescents) most of the day, nearly every day,
as indicated either by subjective ac-count or observation by others
(2) markedly diminished interest or pleasure in all, or almost all, activities
most of the day, nearly every day (as indicated either by subjective ac-count
or observation by others of apathy most of the time)
(3) significant weight loss or weight gain when not dieting (e.g., more than 5o~
of body weight in a month), or decrease or increase in appetite nearly every
day (in children, consider failure to make expected weight gains)
(4) insomnia or, hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed down)
(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 (not merely self-reproach or guilt about being
sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every
day (either by subjective account or as observed by 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
committin2 suicide
B.
(1) It cannot be established that an organic factor initiated and maintained
the disturbance
(2) The disturbance is not a normal reaction to the death of a loved one
(Uncomplicated Bereavement)
Note: Morbid preoccupation with
worthlessness, suicidal ideation, marked functional impairment or psychomotor
retardation, or prolonged duration suggest bereavement complicated by Major
Depression.
C. At no time during the
disturbance have there been delusions or hallucinations for as long as two
weeks in the absence of prominent mood symptoms (i.e., before the mood symptoms
developed or after they have remitted).
D. Not superimposed on
Schizophrenia. Schizophreniform Disorder, Delusional Disorder, or Psychotic
Disorder NOS.
Specify chronic if current episode
has lasted two consecutive years without a period of two months or longer
during which there were no significant depressive symptoms.
Specify if current episode is
Melancholic Type.
The presence of at least five of the following:
(1) loss of interest or pleasure in all, or almost all, activities
(2) lack of reactivity to usually pleasurable stimuli (does not feel much
better, even temporarily, when something good happens)
(3) depression regularly worse in the morning
(4) early morning awakening (at least two hours before usual time of awakening)
(5) psychomotor retardation or agitation (not merely subjective complaints)
(6) significant anorexia or weight loss (e.g., more than 5% of body weight in a
month)
(7) no significant personality disturbance before first Major Depressive
Epi-sode
(8) one or more previous Major Depressive Episodes followed by complete or
nearly complete. recovery
(9) previous good response to specific and adequate somatic
antidepressant therapy . e.g. tricyclics, ECT. MAOI, lithium
A. There has been a regular
temporal relationship between the onset of an episode of Bipolar Disorder
(including Bipolar Disorder NOS) or Recurrent Major Depression (including
Depressive Disorder NOS) and a particular 60-day period of the year (e.g.,
regular appearance of depression between the beginning of October and the end
of November).
Note: Do not include cases in which
there is an obvious effect of seasonally related psychosocial stressors, e.g.,
regularly being unemployed every winter.
B. Full remissions (or a change
from depression to mania or hypomania) also occurred within a particular 60-day
period of the year (e.g., depression disap-pears from mid-February to
mid-April).
C. There have been at least three
episodes of mood disturbance in three sepa-rate years that demonstrated the
temporal seasonal relationship defined in A and B; at least two of the years
were consecutive.
D. Seasonal episodes of mood
disturbance, as described above, outnumbered any nonseasonal episodes of such
disturbance that may have occurred by more than three to one.
A. Depressed mood (or can be irritable mood in children and adolescents) for
most of the day, more days than not, as indicated either by subjective account
or observation by others, for at least two years (one year for children and
adolescents)
B. Presence, while depressed, of at
least two 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 a two-year period
(one-year for children and adolescents) of the disturbance, never without the
symptoms in A for more than two months at a time.
D. No evidence of an unequivocal Major Depressive Episode during the first two
years (one year for children and adolescents) of the disturbance.
Note: There may have been a previous Major Depressive Episode, provided there
was a full remission (no significant signs or symptoms for six months) before
development of the Dysthymia. In addition, after these two years (one year in
children or adolescents) of Dysthymia, there may be superimposed episodes of
Major Depression, in which case both diagnoses are given.
E. Has never had a Manic Episode
(p.217) or an unequivocal Hypomanic Epi-sode (see p.217).
F. Not superimposed on a chronic
psychotic disorder, such as Schizophrenia or Delusional Disorder.
G. It cannot be established that an
organic factor initiated and maintained the disturbance, e.g., prolonged administration
of an antihypertensive medica-tion.
A. For at least two years (one year for children and adolescents), presence of
numerous Hypomanic Episodes (all of the criteria for a Manic Episode, p.217, except
criterion C that indicates marked impairment) and numerous periods with
depressed mood or loss of interest or pleasure that did not meet criterion A of
Major Depressive Episode.
B During a two-year period (one
year in children and adolescents) of the distur-bance, never without hypomanic
or depressive symptoms for more than two months at a time.
C. No clear evidence of a Major
Depressive Episode or Manic Episode during the first two years of the
disturbance (or one year in children and adolescents).
Note: After this minimum period of
Cyclothymia1 there may be superimposed
Manic or Major Depressive Episodes, in which case the additional diagnosis of
Bipolar Disorder or Bipolar Disorder NOS should be given.
D. Not superimposed on a chronic
psychotic disorder, such as Schizophrenia or Delusional Disorder.
E it cannot be established that an
organic factor initiated and maintained the disturbance, e.g., repeated
intoxication from drugs or alcohol.
Note: A "Manic
Syndrome" is defined as inc4uding criteria A, B, and C below. A
"Hypomanic Syndrome" is defined as including criteria A and B, but
not C1 i.e., no marked impairment.
A. A distinct period of abnormally
and persistently elevated, expansive, or irrita-ble mood.
B. During the period of mood
disturbance, at least three of the following symp-toms have persisted (four if
the mood is only irritable I and have been present to a significant degree:
(1) inflated self-esteem or
grandiosity
(2) decreased need for sleep, e.g., feels rested after only three hours of
sleep
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility, i.e., attention too easily drawn to unimportant or
irrelevant external stimuli
(6) increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
(7) excessive involvement in pleasurable activities which have a high
poten-tial for painful consequences, e.g., the person engages in unrestrained
buying sprees. sexual indiscretions, or foolish business investments
C. Mood disturbance sufficiently severe to cause marked impairment in
occupa-tional functioning or in usual social activities or relationships with
others, or to necessitate hospitalization to prevent harm to self or others.
D. At no time during the
disturbance have there been delusions or hallucinations for as long as two
weeks in the absence of prominent mood symptoms (i.e., before the mood symptoms
developed or after they ha\'e remitted).
E. Not superimposed on
Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic
Disorder NOS.
F. lt cannot be established that an
organic factor initiated and maintained the disturbance. Note: Somatic
antidepressant treatment (e.g., drugs, ECTI that apparently precipitates a mood
disturbance should not be considered an etiologic organic factor.
Note: A "Major Depressive Syndrome" is defined as criterion A below.
A. At least five of the following
symptoms have been present during the same two-week period and represent a
change from previous functioning; at least one of the symptoms is either (1)
depressed mood, or (2) loss of interest or pleasure. (Do not include symptoms
that are clearly due to a physical condi-tion, mood-incongruent delusions or
hallucinations, incoherence, or marked loosening of associations.)
(1) depressed mood (or can be
irritable mood in children and adolescents) most of the day, nearly every day,
as indicated either by subjective ac-count or observation by others
(2) markedly diminished interest or pleasure in all, or almost all, activities
most of the day, nearly every day (as indicated either by subjective ac-count
or observation by others of apathy most of the time)
(3) significant weight loss or weight gain when not dieting (e.g., more than 5%
of body weight in a month), or decrease or increase in appetite nearly every
day (in children, consider failure to make expected weight gains)
(4) insomnia or Hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly very day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being
sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every
day (either by subjective account or as observed by 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.
(1) it cannot be established that an organic factor initiated and maintained
the disturbance
(2) The disturbance is not a normal reaction to the death of a loved one
(Uncomplicated Bereavement)
Note: Morbid preoccupation with
worthlessness, suicidal ideation, marked functional impairment or psychomotor
retardation, or prolonged duration suggest bereavement complicated by Major
Depression.
C. At no time during the
disturbance have there been delusions or hallucinations for as long as two
weeks in the absence of prominent mood symptoms (i.e., before the mood symptoms
developed or after they have remitted).
D. Not superimposed on
Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic
Disorder NOS.