Diagnosing Major Depression

The symptoms of major depression are outlined in a sort of cookbook called the Diagnostic and Statistical Manual (4th edition) or DSM-IV. Your doctor or psychologist uses this book along with what you have told him, and what he has observed and tested to form a diagnosis.

A. The person experiences a single major depressive episode:

1. For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning.

One of the symptoms must be either (a) depressed mood, or (b) loss of interest.

a.Depressed mood. For children and adolescents, this may be irritable mood.

2. A significantly reduced level of interest or pleasure in most or all activities.

3. A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.

4. Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).

5. Behavior that is agitated or slowed down. Others should be able to observe this.

6. Feeling fatigued, or diminished energy.

7. Thoughts of worthlessness or extreme guilt (not about being ill).

8. Ability to think, concentrate, or make decisions is reduced.

9. Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide.

10. The person's symptoms do not indicate a mixed episode.

11. The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.

12. The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

13. The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).

B. Another disorder does not better explain the major depressive episode.

C. The person has never had a manic, mixed, or a hypomanic Episode (unless an episode was due to a medical disorder or use of a substance).