Depressed mood for most of the day, for more days than not, as indicated
either by 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.
Presence,
while depressed, of two (or more) of the following:
Poor appetite
or overeating.
Insomnia or hypersomnia.
Low energy or fatigue.
Low self-esteem.
Poor concentration or difficulty making decisions.
Feelings of hopelessness.
Psychomotor agitation
or retardation nearly every day.
During the 2-year period (1 year for children or adolescents) of the
disturbance, the person has never been without the symptoms in Criteria
A and B for more than 2 months at a time.
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.
There has never been a Manic Episode,
a Mixed Episode, or a Hypomanic
Episode, and criteria have never been met for Cyclothymic
Disorder.
The disturbance
does not occur exclusively during the course of a chronic Psychotic
Disorder, such as Schizophrenia
or Delusional Disorder.
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
cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
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.
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.
Markedly diminished
interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or
observation made by others).
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.
Insomnia or hypersomnia
nearly every day.
Psychomotor agitation
or retardation nearly every day (observable by others, not merely
subjective feelings of restlessness or being slowed down).
Fatigue or loss
of energy nearly every day.
Feelings of worthlessness
or excessive or inappropriate guilt (which may be delusional) nearly
every day (not merely self-reproach or guilt about being sick).
Diminished ability
to think or concentrate, or indecisiveness, nearly every day (either
by subjective account or as observed by others).
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.
Manic
Episode:
A distinct period of abnormally and persistently elevated, expansive,
or irritable mood, lasting at least 1 week (or any duration if hospitalization
is necessary).
During the
period of mood disturbance, three (or more) of the following symptoms
have persisted (four if the mood is only irritable) and have been present
to a significant degree:
Inflated self-esteem
or grandiosity.
Decreased need
for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative
than usual or pressure to keep talking.
Insomnia or
hypersomnia nearly every day.
Psychomotor
agitation or retardation nearly every day (observable by others,
not merely subjective feelings of restlessness or being slowed down).
Flight of ideas
or subjective experience that thoughts are racing.
Distractibility
(i.e., attention too easily drawn to unimportant or irrelevant external
stimuli).
Increase in
goal-directed activity (either socially, at work or school, or sexually)
or psychomotor agitation.
Excessive involvement
in pleasurable activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)
The symptoms do not meet criteria for a Mixed
Episode
The mood
disturbance is sufficiently severe to cause marked impairment in occupational
functioning or in usual social activities or relationships with others,
or to necessitate hospitalization to prevent harm to self or others,
or there are psychotic features.
The symptoms
are not due to the direct physiological effects of a substance (e.g.,
a drug of abuse, a medication, or other treatment) or a general medical
condition (e.g., hyperthyroidism).
Mixed
Episode:
The criteria are met both for a Manic Episode
and for a Major Depressive Episode
(except for duration) nearly every day during at least a 1-week period.
The mood
disturbance is sufficiently severe to cause marked impairment in occupational
functioning or in usual social activities or relationships with others,
or to necessitate hospitalization to prevent harm to self or others,
or there are psychotic features.
The symptoms
are not due to the direct physiological effects of a substance (e.g.,
a drug of abuse, a medication, or other treatment) or a general medical
condition (e.g., hyperthyroidism).
Hypomanic
Episode:
A distinct period of persistently elevated, expansive, or irritable
mood, lasting throughout at least 4 days, that is clearly different
from the usual nondepressed mood.
During the
period of mood disturbance, three (or more) of the following symptoms
have persisted (four if the mood is only irritable) and have been present
to a significant degree:
Inflated self-esteem
or grandiosity.
Decreased need
for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative
than usual or pressure to keep talking.
Flight of ideas
or subjective experience that thoughts are racing.
Distractibility
(i.e., attention too easily drawn to unimportant or irrelevant external
stimuli).
Increase in
goal-directed activity (either socially, at work or school, or sexually)
or psychomotor agitation.
Excessive involvement
in pleasurable activities that have a high potential for painful
consequences (e.g., the person engages in unrestrained buying sprees,
sexual indiscretions, or foolish business investments).
The episode is associated with an unequivocal change in functioning
that is
uncharacteristic of the person when not
symptomatic.
The disturbance
in mood and the change in functioning are observable by others.
The episode is not severe enough to cause marked impairment in social
or occupational functioning, or to necessitate hospitalization, and
there are no psychotic features.
The symptoms
are not due to the direct physiological effects of a substance (e.g.,
a drug of abuse, a medication, or other treatment) or a general medical
condition (e.g., hyperthyroidism).
Associated
Features
Depressed
Mood
Somatic
or Sexual
Dysfunction
Guilt or Obsession
Addiction
Anxious or Fearful or Dependent
Personality
Dramatic or Erratic or Antisocial
Personality
Differential
Diagnosis
Some disorders have similar or even overlapping symptoms. The clinician,
therefore, in his diagnostic attempt has to differentiate against the
following disorders which need to be ruled out to establish a precise
diagnosis.
Psychiatric:
Manic, Mixed, or Hypomanic Episode; Mood Disorder Due to a General Medical
Condition; Substance-Induced Mood Disorder; Schizoaffective
Disorder; Schizophrenia;
Delusional Disorder; Psychotic
Disorder Not Otherwise Specified; Dementia;
Major Depressive Disorder; chronic Psychotic Disorders; coexisting
personality disturbance.
Medical:
Organic Mood Syndromes caused by: Acquired Immune Deficiency Syndrome
(AIDS), Adrenal (Cushing's or Addison's Diseases), Cancer (especially
pancreatic and other GI), Cardiopulmonary disease, Dementias
(including Alzheimer's Disease);
Epilepsy,
Fahr's Syndrome, Huntington's Disease, Hydrocephalus,
Hyperaldosteronism, Infections (including HIV and neurosyphilis), Migraines,
Mononucleosis, Multiple Sclerosis, Narcolepsy,
Neoplasms, Parathyroid Disorders (hyper- and hypo-), Parkinson's
Disease, Pneumonia (viral and bacterial), Porphyria, Postpartum,
Premenstrual Syndrome, Progressive Supranuclear Palsy, Rheumatoid Arthritis,
Sjogren's Arteritis, Sleep Apnea, Stroke,
Systemic Lupus Erythematosus, Temporal Arteritis, Trauma, Thyroid Disorders
(hypothyroid and "apathetic" hyperthyroidism), Tuberculosis,
Uremia (and other renal diseases), Vitamin Deficiencies (B12, C, folate,
niacin, thiamine), Wilson's Disease.
Drugs:
Acetazolamine, Alphamethyldopa, Amantadine, Amphetamines, Ampicillin,
Azathioprine (AZT), 6-Azauridine, Baclofen, Beta Blockers, Bethanidine,
Bleomycin, Bromocriptine, C-Asparaginase, Carbamazepine, Choline, Cimetidine,
Clonidine, Clycloserin, Cocaine, Corticosteroids (including ACTH), Cyproheptadine,
Danazol, Digitalis, Diphenoxylate, Disulfiram, Ethionamide, Fenfluramine,
Griseofulvin, Guanethidine, Hydralazine, Ibuprofen, Indomethacin, Lidocaine,
Levodopa, Methoserpidine, Methysergide, Metronidazole, Nalidixic Acid,
Neuroleptics (butyrophenones, phenothiazines, oxyindoles), Nitrofurantoin,
Opiates, Oral Contraceptives, Phenacetin, Phenytoin, Prazosin, Prednisone,
Procainamide, Procyclidine, Quanabenzacetate, Rescinnamine, Reserpine,
Sedative/Hypnotics (barbiturates, benzodiazepines, chloral hydrate),
Streptomycin, Sulfamethoxazole, Sulfonamides, Tetrabenazine, Tetracycline,
Triamcinolone, Trimethoprim, Veratrum, Vincristine.
