MDCalc

DSM-5 Criteria for Major Depressive Disorder

Diagnostic criteria for major depressive disorder (MDD).

Depressive symptoms

≥5 symptoms during the same two week period that are a change from previous functioning; depressed mood and/or loss of interest/pleasure must be present; exclude symptoms clearly attributable to another medical condition

Most of the day, nearly every day; may be subjective (e.g. feels sad, empty, hopeless) or observed by others (e.g. appears tearful); in children and adolescents, can be irritable mood
Markedly diminished interest/pleasure in all (or almost all) activities most of the day, nearly every day; may be subjective or observed by others
Significant weight loss (without dieting) or gain (change of >5% body weight in a month), or decrease or increase in appetite nearly every day; in children, may be failure to gain weight as expected
Nearly every day
Nearly every day and observable by others (not merely subjectively restless or slow)
Or loss of energy, nearly every day
Nearly every day; guilt may be delusional; not merely self reproach or guilt about being sick
Nearly every day; may be indecisiveness; may be subjective or observed by others
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt, or a specific plan for suicide

Additional required criteria

Must have all 4, plus ≥5 depressive symptoms above

Exclusion does not apply if all manic-like or hypomanic-like episodes are substance-induced or are attributable to physiological effects of another medical condition

Diagnostic Result

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Advice
  • In patients who meet criteria for the diagnosis of Major Depressive Disorder, a comprehensive treatment plan should be created.
  • This plan may include psychotherapy and/or pharmacotherapy, along with the expertise of a psychiatrist or psychologist as needed. Be sure to also discuss a safety plan with those patients who are at elevated risk. 
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