Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

DSM-IV Criteria for Major Depressive Disorder

Major depression is a syndrome with well-defined clinical features. Essential features of a major depressive episode include 5 or more of the following symptoms over a 2 week period. One symptom must include either depressed mood or a marked loss of interest or pleasure for at least two consecutive weeks.

Note: The symptoms may be defined by subjective or objective description.

  • Depressed mood most of the day, nearly every day (e.g., feels sad, empty or appears tearful)
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
  • Significant weight loss (change of more than 5%)
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
  • Recurrent thoughts of death (not just fear of dying)
  • The symptoms do not meet the criteria for a mixed episode
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas or 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, 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
  • Postpartum onset specifier: Onset of episode within 4 weeks postpartum