A. A mood disturbance, defined as follows:
- at least two (but less than five) 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 (a) or (b):
- a. 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.
- b. 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)
- c. 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.
- d. insomnia or hypersomnia nearly every day
- e. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
- f. fatigue or loss of energy nearly every day
- g. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- h. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
- i. 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 cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- the symptoms are not due the 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., a normal reaction to the death of a loved one)
C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria are not met for Cyclothymic Disorder. Note: This exclusion does not apply if all of the manic-, mixed-, or hypomanic-like episodes are substance or treatment induced.
In DSM-IV, individuals whose presentation meets these research criteria would be diagnosed as having Adjustment Disorder With Depressed Mood if the depressive symptoms occur in response to a psychosocial stressor; otherwise, the appropriate diagnosis is Depressive Disorder Not Otherwise Specified.
An episode of minor depressive disorder is distinguished from a Major Depressive Episode by the required number of symptoms (two to four symptoms for minor depressive disorder and at least five symptoms for a Major Depressive Disorder). This proposed disorder is considered to be a residual category and is not to be used if there is a history of a Major Depressive Episode, Manic Episode, Mixed Episode, or Hypomanic Episode, or if the presentation meets criteria for Dysthymic or Cyclothymic Disorder.
Symptoms meeting research criteria for minor depressive disorder can be difficult to distinguish from periods of sadness that are an inherent part of everyday life. This proposed disorder requires that the depressive symptoms be present for most of the day nearly every day for at least 2 weeks. In addition, the depressive symptoms must cause clinically significant distress or impairment.
Depressive symptoms occurring in response to the loss of a loved one are considered Bereavement (unless they meet the criteria for a Major Depressive Episode.
Substance-Induced Mood Disorder is distinguished from this disturbance in that the depressive symptoms are due to the direct physiological effects of a drug of abuse (e.g., alcohol or cocaine) or the side effects of a medication (e.g., steroids).
Mood Disorder Due to a General Medical Condition is distinguished from this disturbance in that the depressive symptoms are due to the direct physiological effects of a general medical condition (e.g., hypothyroidism).
Because depressive symptoms are common associated features of psychotic disorders, they do not receive a separate diagnosis if they occur exclusively during Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
Other mental disorders
The relationship between this proposed disorder and several other proposed categories (i.e., recurrent brief depressive disorder, depressive personality disorder, and mixed anxiety-depressive disorder) and with other Personality Disorders is not known, but substantial overlap may exist among them.