Criteria
International classification of diseases, eleventh edition (ICD-11)[2]
ICD-11 depressive disorders are subdivided into single-episode and recurrent types, with designations for severity of the most recent episode and, in severe cases, the presence or absence of psychosis (hallucinations or delusions).
Symptoms include:
Depressed mood
Diminished interest/capacity for pleasure
Change in sleep
Psychomotor change
Reduced energy; fatigue
Feelings of worthlessness; excessive or inappropriate guilt
Hopelessness
Difficulty concentrating
Recurrent thoughts of death or suicide.
Mild depression is diagnosed when no symptom is present to an intense degree and there is some, but not considerable, functional impairment.
Moderate depression denotes several symptoms present to a marked degree and considerable but not complete functional impairment.
Severe depression is diagnosed when many or most of the characteristic symptoms of depression are present to a marked degree, and/or several are present to an intense degree, and there is complete or near-complete functional impairment.
Note: the presence of psychotic symptoms by definition defines an episode as moderate or severe.
Additionally, ICD-11 includes under the depressive disorder category a diagnosis of dysthymic disorder, and a new one for mixed anxiety and depressive disorder.
Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR)[1]
DSM-5-TR divides depressive disorders into:
Disruptive mood dysregulation disorder
Major depressive disorder (including major depressive episode)
Persistent depressive disorder (previously known as dysthymic disorder)
Premenstrual dysphoric disorder
Substance-/medication-induced depressive disorder
Depressive disorder due to another medical condition
Other specified depressive disorders
Unspecified depressive disorder
Unspecified mood disorder.
Major depression[1]
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 depressed mood or loss of interest or pleasure:
Depressed mood most of the day, nearly every day, as self-reported or observed by others
Markedly diminished interest or pleasure in all or almost all activities, for most of the day, nearly every day
Significant weight loss when not dieting, weight gain or decrease, or increase in appetite nearly every day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a specific suicide plan, or a suicide attempt.
In addition, these symptoms:
Cause functional impairment (e.g., social, occupational)
Are not better explained by substance abuse, medication side effects, or other psychiatric or somatic medical conditions.
There are 3 degrees of severity of major depression defined in the DSM-5-TR:
Mild: few, if any, symptoms more than number required for diagnosis of major depression, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor functional impairment
Moderate: the number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for ‘mild’ and ‘severe’ depression
Severe: the number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.
The following specifiers may be added to the diagnosis of depressive disorder:
With anxious distress
With mixed features (if there are at least 3 associated manic/hypomanic symptoms)
With melancholic features
With atypical features
With psychotic features
With catatonia
With peripartum onset
With seasonal pattern.
Depressive disorder (subthreshold or minor depression)
Subthreshold (minor) depression is not defined in DSM-5-TR, but when used in the past it referred to a patient who had from 2-4 depressive symptoms, including either sad mood or anhedonia for at least 2 weeks.[5]
Depressive disorder due to:
Substance/medication use/abuse: full or partial major depressive syndrome attributable to pharmaceuticals or other intoxicants
Medical condition: full or partial major depressive syndrome attributable to another somatic medical illness
Other (specified or unspecified) depressive disorder: major depressive syndrome attributable to another external or somatic cause, or a depressive syndrome that for other known or unknown reasons falls short of a full major depressive syndrome.
Persistent depressive disorder[1]
Depressed mood, for more days than not, for ≥2 years. Impairment compared with major depressive disorder may be less severe. During the 2 years, the patient has never been without symptoms for more than 2 months at a time.
Two or more of the following symptoms are present while depressed:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Fatigue
Poor concentration or difficulty making decisions
Feelings of hopelessness.
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