Major Depressive Episode

Five or more of the following symptoms present during the same two-week period and representing a change from previous functioning:

• depressed mood or loss of interest or pleasure (at least one); does not include symptoms clearly due to a general medical condition, mood-incongruent delusions, or hallucinations

• depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others; 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 or decrease/ increase in appetite nearly every day; 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 suicide attempt or specific plan for committing suicide

Criteria for Mixed Episode not met

Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

(for example, weight loss, suicidal thinking) which is rated for severity. The BDI can be self-administered or can be completed by an interviewer.

Since its introduction, the BDI has become one of the most widely used measures of depression for both research and clinical purposes. Many studies have shown that the BDI is an accurate and useful measure of depression. For example, BDI scores have been found to be related to both clinicians' ratings of the severity of a patient's depression and clinical improvements during the course of treatment for depression as well as being able to discrimi-

Symptoms not due to direct physiological effects of a substance or general medical condition

Symptoms not better accounted for by bereavement, persist for longer than two months, or characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psy-chomotor retardation

Major Depressive Disorder, Single Episode (DSM code 296.2X)

Presence of single Major Depressive Episode

Major Depressive Episode not better accounted for by Schizoaffective Disorder and not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified

No Manic Episodes, Mixed Episodes, or Hypomanic Episodes, unless all manic-like, mixed-like, or hypomanic-like episodes are substance- or treatment-induced or due to direct physiological effects of a general medical condition Specify for current or most recent episode: Severity/Psychotic/Remission Specifiers; Chronic; with Catatonic Features; with Melancholic Features; with Atypical Features; with Postpartum Onset

Major Depressive Disorder, Recurrent (DSM code 296.3X)

Presence of two or more Major Depressive Episodes; with an interval of at least two consecutive months in which criteria not met for Major Depressive Episode

Major Depressive Episodes not better accounted for by Schizoaffective Disorder and not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified

No Manic Episodes, Mixed Episodes, or Hypomanic Episodes, unless all manic-like, mixed-like, or hypomanic-like episodes are substance- or treatment-induced or due to direct physiological effects of a general medical condition Specify for current or most recent episode: Severity/Psychotic/Remission Specifiers; Chronic; with Catatonic Features; with Melancholic Features; with Atypical Features; with Postpartum Onset

Specify: Longitudinal Course Specifiers (with and Without Interepisode Recovery); with Seasonal Pattern nate between the diagnosis of clinical depression and other conditions.

Psychologist Maria Kovacs developed the Children's Depression Inventory (CDI) by modifying the BDI for use with children. Similar in format to the BDI, the CDI contains twenty-eight items, each of which concerns a symptom of depression that is rated for severity. Research has supported the utility of the CDI. CDI ratings have been found to be related to clinicians' ratings of childhood depression. CDI scores have also been found to discriminate children hospitalized for depression from children hospitalized for other disorders. The CDI (along with other measures of childhood depression) has contributed to psychology's research on and understanding of the causes and treatment of childhood depression.

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