1 Boring Old Man

^{[1] poor appetite or significant weight loss [when not dieting] or increased appetite or significant weight gain [in children under six, consider failure tomake expected weight gains]}

^{[2] insomnia or hypersomnia}

^{[3] psychomotor agitation or retardation [not merely subjective feelings of restlessness or being slowed down][in children under six, hypoactivity]}

^{[4] loss of interest or pleasure in usual activities, or decrease in sexual drive not limited to a period when delusional or hallucinating [in children under six, signs of apathy]}

^{[5] loss of energy; fatigue}

^{[6] feelings of worthlessness, self reproach, or excessive or inappropriate guilt [either may be delusional]}

^{[7] complaints or evidence of diminished ability to think or concentrate, such as slowed thinking, or indecissiveness not associated with marked loosening of association or incoherence}

^{[8] recurrent thoughts of death, suicide ideation, wishes to be dead, or suicide attempt}

^{[1] preoccupation with a mood-incongruent delusion or hallucination [see definition below]}

^{[2] bizarre behavior}

^{6- In Remission…}

^{4- With Psychotic Features…}
^{Mood-congruent Psychotic Features:…}
_{Mood-incongruent Psychotic Features:…}
^{3- With Melancholia}
^{A. Loss of pleasure in all or almost all activities}

^{B. Lack of reactivity to usually pleasurable stimuli [doesn’t feel much better, even temporarily, when something good happens].}

^{C. At least three of the following:}

^{[a] distinct quality of depressed mood, i.e. the depressed mood is perceived as distinctly different from the kind of feeling experience following the death of a loved one}
^{[b] the depression is regularly worse in the morning}
^{[c] early morning awakening [at least two hours before usual time of awakening]}
^{[d] marked psychomotor retardation or agitation}
^{[e] significant anorexia or weight loss}
^{[f] excessive or inappropriate guilt}
^{2- Without Melancholia}
^{0- Unspecified.}

^{[1] depressed mood [or can be irritable mood in children and adolescents] most of the day, nearly every day, as indicated by a subjective account or observed by others.}

^{[2] markedly diminished interest or pleasure in all, or almost all,activities most of the day, nearly every day [as indicated by either a subjective account or observations by others of apathy most of the time]}

^{[3] significant weight loss or weight gain when not dieting [e.g., more than 5% of body weight in a month], or decrease or increase in appetite every day [in children, consider failure to make expected weight gains]}

^{[4] insomnia or hypersomnia nearly every day}

^{[5] psychomotor agitation or retardation nearly every day [observable by others, not merely subjective feelings of restlessness or being slowed down]}

^{[6] fatigue and loss of energy nearly every day}

^{[7] feelings of worthlessness or excessive or inappropriate guilt [which may be delusional] nearly every day [not merely self reproach or guilt about being sick]}

^{[8] diminished ability to think or concentrate, or indecisiveness, nearly every day [either by subjective account or observed by others]}

^{[9] 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}

^{[1] It cannot be established that an organic factor initiated and maintained the disturbance}

^{[2] The disturbance is not a normal reaction to the death of a loved one [Uncomplicated Bereavement]}

^{Note: Morbid preoccupation with worthiness, suicidal ideation, marked functional impairment or psychomotor retardation, or prolonged duration suggest bereavement complicated by Major Depression.}

^{1- Mild:…}
^{2- Moderate:…}
^{3- Severe, without Psychotic Features:…}
^{4- With Psychotic Features…}
^{Mood-congruent Psychotic Features:…}
_{Mood-incongruent Psychotic Features:…}
^{5- In Partial Remission…}
^{6- In Remission…}
^{0- Unspecified.}

^{Specify chronic if current episode has lasted two consequetive years without a period of two months or longer during which there was no significant depressive symptoms.}

^{Specify if current episode is Melancholic Type.}

^{[1] Loss of pleasure in all or almost all activities}
^{[2] Lack of reactivity to usually pleasurable stimuli [doesn’t feel much better, even temporarily, when something good happens].}
^{[3] the depression is regularly worse in the morning}
^{[4] early morning awakening [at least two hours before usual time of awakening]}
^{[5] psychomotor retardation or agitation [not merely subjective complaints]}

^{[6] significant anorexia or weight loss [e.g., more than 5% of body weight in a month]}

^{[7] no significant personality disturbance before the first Major Depressive Episode}

^{[8] one or more previous Major Depressive Episodes followed by complete, or nearly complete, recovery}
^{[9] previous good response to specific and adequate somatic antidepressant therapy, e.g., tricyclics, ECT, MAOI, lithium}