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Depressive Disorders DSM-IV Criteria

Major Depressive Disorder, Single Episode (296.2x)
  • Presence of a single Major Depressive Episode (see below).
  • The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (NOS).
  • There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance- or treatment-induced or are due to the direct physiological effects of a general medical condition.
If the full criteria are currently met for a Major Depressive Episode, specify its current clinical status and/or features:
  • Mild, Moderate, Severe without Psychotic Features, Severe with Psychotic Features
  • Chronic
    • with Catatonic Features
    • with Melancholic Features
    • with Atypical Features
    • with Postpartum Onset
If the full criteria are not currently met for a Major Depressive Episode, specify the current clinical status of the Major Depressive Disorder or features of the most recent episode:
  • In Partial Remission, in Full Remission
  • Chronic
    • with Catatonic Features
    • with Melancholic Features
    • with Atypical Features
    • with Postpartum Onset
Major Depressive Disorder, Recurrent (296.3x)
  • Presence of two or more Major Depressive Episodes (see below).
    Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
  • The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.
  • There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
    Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.
If the full criteria are currently met for a Major Depressive Episode, specify its current clinical status and/or features:
  • Mild, Moderate, Severe Without Psychotic Features; Severe With Psychotic Features
  • Chronic
    • with Catatonic Features
    • with Melancholic Features
    • with Atypical Features
    • with Postpartum Onset
If the full criteria are not currently met for a Major Depressive Episode, specify the current clinical status of the Major Depressive Disorder or features of the most recent episode:
  • In Partial Remission, in Full Remission
  • Chronic
    • with Catatonic Features
    • with Melancholic Features
    • with Atypical Features
    • with Postpartum Onset
Specify:
  • Longitudinal Course Specifiers (With and Without Interepisode recovery)
  • With Seasonal Pattern
Dysthymic Disorder (300.4)
  1. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
    Note:
    In children and adolescents, mood can be irritable and duration must be at least 1 year.
  2. Presence, while depressed, of two (or more) 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
  3. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria 1 and 2 for more than 2 months at a time.
  4. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, in partial remission.
    Note:
    There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In Addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.
  5. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
  6. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
  7. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
  8. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
  • Early Onset: if onset is before age 21 years
  • Late Onset: if onset is at age 21 years or older
Specify (for most recent 2 years of Dysthymic Disorder):
  • With Atypical Features
Depressive Disorder Not Otherwise Specified (311)
The Depressive Disorder Not Otherwise Specified category includes disorders with depressive features that do not meet the criteria for Major Depressive Disorder, Dysthymic Disorder, Adjustment Disorder with Depressed Mood, or Adjustment Disorder with Mixed Anxiety and Depressed Mood. Sometimes depressive symptoms can present as part of an Anxiety Disorder Not Otherwise Specified. Examples of Depressive Disorder Not Otherwise Specified include:
  1. Premenstrual dysphoric disorder: in most menstrual cycles during the past year, symptoms (e.g., markedly depressed mood, marked anxiety, marked affective lability, decreased interest in activities) regularly occurred during the last week of the luteal phase (and remitted within a few days of the onset of menses). These symptoms must be severe enough to markedly interfere with work, school, or usual activities and be entirely absent for at least 1 week postmenses.
  2. Minor depressive disorder: episodes of at least 2 weeks of depressive symptoms but with fewer than the five items required for Major Depressive Disorder.
  3. Recurrent brief depressive disorder: depressive episodes lasting from 2 days up to 2 weeks, occurring at least once a month for 12 months (not associated with the menstrual cycle).
  4. Postpsychotic depressive disorder of Schizophrenia: a Major Depressive Episode that occurs during the residual phase of Schizophrenia.
  5. A Major Depressive Episode superimposed on Delusional Disorder, Psychotic Disorder Not Otherwise Specified, or the active phase of Schizophrenia.
  6. Situations in which the clinician has concluded that a depressive disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced.

Mood Disorder Not Otherwise Specified (296.90)
This category includes disorders with mood symptoms that do not meet the criteria for any specific Mood Disorder (e.g., Major Depressive Disorder) and in which it is difficult to choose between Depressive Disorder Not Otherwise Specified and Bipolar Disorder Not Otherwise Specified (e.g., acute agitation).

Major Depressive Episode
  • 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 (1) depressed mood or (2) loss of interest or pleasure.Note: Do not include symptoms that are clearly due to a general medical condition, or mood incongruent delusions or hallucinations.
    1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by 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 indicted by either subjective account or observation made by others)
    3. 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 gains.
    4. Insomnia or hypersomnia nearly every day
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings or 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
  • The symptoms do not meet criteria for a mixed episode.
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
  • The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, 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.

Authors

Author: Thomas G. Conover, MD - 4/2010

Page Bibliography

American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision).
4th edition (June 2000) ed. Washington, DC: American Psychiatric Association; 2000. 0890420254