Major Depressive Disorder DSM-5 Criteria Diagnosis

Major Depressive Disorder DSM-5 Criteria Explained

The DSM-5 criteria helps diagnose major depressive disorder based on an array of depressive symptoms (9 out of which at least 5 must be met) and four additional required criteria.

The depression symptoms focus on the following:

• Depressed mood;
• Loss of interest/pleasure;
• Weight loss or gain;
• Insomnia or hypersomnia;
• Psychomotor agitation or retardation;
• Fatigue;
• Feeling worthless or excessive/inappropriate guilt;
• Decreased concentration;
• Thoughts of death/suicide.

The additional four criteria ensure the effectiveness of diagnosis by eliminating other possible causes:

• Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
• Episode not attributable to physiological effects of a substance or another medical condition
• Episode not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
• No history of manic or hypomanic episode. Exclusion does not apply if all manic-like or hypomanic-like episodes are substance-induced or are attributable to physiological effects of another medical condition

Major depressive disorder is a highly prevalent psychiatric disorder (one of the leading causes of disability worldwide) that is usually diagnosed when an individual has a persistently low or depressed mood, shows little interest in otherwise pleasurable activities, may experience feelings of guilt or worthlessness and other symptoms.

Per DSM-5, other types of depression falling under the category of depressive disorders are:

• Persistent depressive disorder, formerly known as dysthymia;
• Disruptive mood dysregulation disorder;
• Premenstrual dysphoric disorder;
• Substance/medication-induced depressive disorder;
• Depressive disorder due to another medical condition;
• Unspecified depressive disorder.

Individuals with MDD are at a high risk of developing comorbid anxiety disorders and substance use disorders.

In primary care settings, the Patient Health Questionnaire-9 (PHQ-9) is commonly used for screening, diagnosing, and monitoring treatment response for MDD. This is a self-report tool presented as a standardized depression rating scale. Additionally the Hamilton Rating Scale for Depression (HAM-D), which is a clinician-administered rating scale, may be used.

References

American Psychiatric Association: Desk Reference to the Diagnostic Criteria From DSM-5. Arlington, VA, American Psychiatric Association, 2013.

Tolentino JC, Schmidt SL. DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry. 2018; 9:450.