Major Depressive Disorder

Diagnostic Questions

Updated: October 10, 1996

A. At least one of the following three abnormal moods which significantly interfered with the person's life:

  1. Abnormal depressed mood most of the day, nearly every day, for at least 2 weeks.

    In your lifetime, everyday for at least 2 weeks ...

      Did you ever feel depressed, sad or empty?
    And ... Did this interfere with your life a lot?
    And ... Was this clearly different from your usual functioning?

  2. Abnormal loss of all interest and pleasure most of the day, nearly every day, for at least 2 weeks.

    In your lifetime, when you were low, everyday for at least 2 weeks ...

      Did you lose practically all interest or pleasure in doing things?
    And ... Did this interfere with your life a lot?
    And ... Was this clearly different from your usual functioning?

  3. If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least 2 weeks.

    Before Age 18, For At Least 2 Weeks ...

      Were you ever so irritable or angry that this interfered with your life a lot?
    And ... Was this clearly different from your usual functioning?

    Note: There is an awareness in American psychiatry that depression may present primarily with irritable, rather than depressed or apathetic mood. This is not officially recognized yet for adults, but it is recognized for children and adolescents.

B. At least five of the following symptoms have been present during the same 2 week depressed period.

  1. Abnormal depressed mood (or irritable mood if a child or adolescent) [as defined in criterion A].

  2. Abnormal loss of all interest and pleasure [as defined in criterion A2].

  3. Appetite or weight disturbance, either:

    When this low mood was at its worst, everyday for at least 2 weeks ...

      Did you have a poor appetite or overeat?
    And ... And ... Did your weight change as much as 10 pounds (4.5 kg) altogether?
    And ... Was this clearly different from your usual functioning?
    Note: In children, consider failure to make expected weight gains.

  4. Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.

    When this low mood was at its worst, everyday for at least 2 weeks ...

      Did you have trouble falling or staying asleep, or sleeping too much?
    And ... Was this clearly different from your usual functioning?

  5. Activity disturbance, either abnormal agitation or abnormal slowing (observable by others).

    When this low mood was at its worst, everyday for at least 2 weeks ...

      Were you unable to sit still and paced back and forth, OR did you talk or move so slowly that other people noticed that it was abnormal?
    And ... Was this clearly different from your usual functioning?

  6. Abnormal fatigue or loss of energy.

    When this low mood was at its worst, everyday for at least 2 weeks ...

      Did you feel tired all the time even when you hadn't been working very hard?
    And ... Was this clearly different from your usual functioning?

  7. Abnormal self-reproach or inappropriate guilt.

    When this low mood was at its worst, everyday for at least 2 weeks ...

      Did you feel worthless, sinful, or guilty?
    And ... Was this clearly different from your usual functioning?
    Note: Don't include self-reproach or guilt about being sick.

  8. Abnormal poor concentration or indecisiveness.

    When this low mood was at its worst, everyday for at least 2 weeks ...

      Did you have a lot more trouble concentrating on things, such as reading the newspaper or watching television?
    And ... Was this clearly different from your usual functioning?

  9. Abnormal morbid thoughts of death (not just fear of dying) or suicide.

    When this low mood was at its worst ...

      Everyday for at least 2 weeks, did you think a lot about death, about hurting yourself in some way?
    Or ... Did you attempt suicide?
    And ... Was this clearly different from your usual functioning?

C. The symptoms are not due to a mood-incongruent psychosis.

For At Least 2 Weeks, When Your Mood Was Not Very High Or Low ...

  Did you ever believe things that other people found hard to believe, like people were plotting against you?
Or ... Hearing voices or seeing visions that nearby people couldn't?
Or ... Having supernatural powers?
And ... Was this NOT due to physical illness, medication or street drugs?

Instructions:

Scoring: The person would answer "no" to the above question.
Note: A mood-incongruent psychosis has delusions or hallucinations whose content does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. Included here are such symptoms as persecutory delusions (not directly related to depressive themes), thought insertion, thought broadcasting, and delusions of being possessed or under the control of an alien being.

D. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.

In Your Lifetime, Everyday For At Least 1 Week ...

  Were you ever so happy, excited, or hyper that you got into trouble, friends worried about it, or a doctor said you were manic?
And ... Was this clearly different from your usual functioning?
And ... Was this NOT due to physical illness, medication or street drugs?

Instructions:

Scoring: The person would answer "no" to the above question.
Note: If the person answers "yes", mania must be ruled out by a more detailed Bipolar Disorder inquiry.

E. The symptoms are not due to physical illness, alcohol, medication, or street drugs.

Just Before This Low Mood Began ...

  Were you physically ill, drinking alcohol, taking any medications or street drugs?
And ... Did your doctor say this was the cause of your depression?

Instructions:

Scoring: The person would answer "no" to the above question.
Note: If the person answers "yes", the following disorders must be ruled out by a more detailed inquiry: Mood Disorder Due to a General Medical Condition, Alcohol-Induced Mood Disorder, or Other Substance-Induced Mood Disorder .

F. The symptoms are not due to normal bereavement.

In The 6 Months Before The Start Of This Low Mood ...

  Did someone close to you die?
And ... Would you say your depression was a normal reaction to the death of a loved one?

Instructions:

Scoring: The person would answer "no" to the above question.
Note: Depression would be considered a normal reaction to the death of a loved one if:
  • The depressive symptoms were acute (lasting less than 3 months)
  • Functional impairment was not marked
  • Psychomotor retardation, suicidal thoughts, or psychosis were absent

Internet Mental Health (www.mentalhealth.com) copyright 1995-2003 by Phillip W. Long, M.D.