296.23 Major Depressive Disorder, Single Episode, Severe without psychotic features
DSM Criteria Major Depressive Disorder, Single Episode
A. Presence of a single Major Depressive Episode
DSM Criteria for Major Depressive Episode (p.356)
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
According to James, he has felt “down” ever since he had a fight with his father a few months ago.
James says that his mood has been much worse in the last 2 months.
He feels depressed almost every day, all day long.

(2) 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)
James has lost interest in school and social activities and has not paid serious attention to his schoolwork for the last 2 months.

(3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) Insomnia or hypersomnia nearly every day
He is tired all the time and takes a nap when he comes home from school. At night, he has trouble falling asleep, and in morning, he often has trouble getting up.

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

Depressed mood observed by mother and college counselor.

(6) Fatigue or loss of energy nearly every day
He is tired all the time and takes a nap when he comes home from school.

(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)

He thinks that the trouble with his father is his fault and that if he were a “better son” his father would love him.
In recent weeks and especially when he thinks about the fight with his father James begins to think that he does not want to live.

(8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
His grades have dropped from A’s to D’s

(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
Two weeks ago he thought about cutting his wrists with a knife ,but the thought of how upset his mother and siblings would be kept him from doing