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Q. What are the diagnostic criteria for depression?
Depression comes in many forms and in many degrees. Below, you will
find some of the most common depressive types, along with some of the
diagnostic criteria from the DSM-III-R (the official diagnostic and
statistical manual for psychiatric illnesses).
**Major Depression:** This is a most serious type of depression. Many
people with a major depression can not continue to function normally.
The treatments for this are medication, psychotherapy and, in extreme
cases, electroconvulsive therapy (ECT).
Diagnostic criteria:
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 condition, mood-
incongruent delusions or hallucinations, incoherence, or marked
loosening of associations.)
1. depressed mood most of the day, nearly every day, as indicated
either by subjective account 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 account 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
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 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
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
**Dysthymia:** This is a mild, chronic depression which lasts for two
years or longer. Most people with this disorder continue to function
at work or school but often with the feeling that they are "just
going through the motions." The person may not realize that they are
depressed. Anti-depressants or psychotherapy can help.
Diagnostic criteria:
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 difficult 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.
E. Has never had a Manic Episode or an unequivocal Hypo manic
Episode.
F. Not superimposed on a chronic psychotic disorder, such as
Schizophrenia or Delusional Disorder.
G. It cannot be established that an organic factor initiated or
maintained the disturbance, e.g., prolonged administration of an
antihypertensive medication.
**Adjustment Disorder with Depressed Mood:** This is the type of
depression that results when a person has something bad happen to
them that depresses them. For example, loss of one's job can cause
this type of depression. It generally fades as time passes and the
person gets over what ever it was that happened.
Diagnostic criteria:
A. A reaction to an identifiable psycho social stressor (or multiple
stressors) that occurs within three months of onset of the
stressor(s).
B. The maladaptive nature of the reaction is indicated by either of
the following:
1. impairment in occupational (including school) functioning or in
usual social activities or relationships with others
2. symptoms that are in excess of a normal and expectable reaction
to the stressor(s)
C. The disturbance is not merely one instance of a pattern of
overreaction to stress or an exacerbation of one of the mental
disorders previously described (in the entire DSM).
D. The maladaptive reaction has persisted for no longer than six
months.
E. The disturbance does not meet criteria for any specific mental
disorder and does nor represent Uncomplicated Bereavement.
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