What Are The DSM 5 Depression Criteria?

Updated January 18, 2023by BetterHelp Editorial Team

Most people are sad from time to time, but not everyone who experiences sadness receives a diagnosis of depression. So, how does a medical professional determine whether you’re depressed or not? The answer lies in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM-5 lays out the criteria for clinical depression explicitly and is what mental health professionals use to diagnose conditions like depression.

Wondering If You’re Experiencing Symptoms Of Depression?

DSM 5 Criteria For Depression

The DSM 5 definition of depression is more than a simple one-sentence description. Instead, it’s a detailed and comprehensive explanation of different symptoms that indicate a depressive disorder. In addition to listing and describing symptoms, the DSM gives specific rules for making that diagnosis.

Major Depression DSM 5 Criteria 

Major depressive disorder is a serious mood disorder and medical condition affecting millions worldwide. It is a specific type of depression. The official criteria for the disorder can be found in the Diagnostic And Statistical Manual created by the American Psychiatric Association (DSM-5, formerly DSM-IV-TR). To be officially diagnosed, you must have at least five of the following diagnostic criteria for major depressive disorder (that are determined by clinical judgment):

  1. A depressed mood.

  2. Loss of interest or pleasure in most activities.

  3. Significant weight loss or gain that is unintentional or a significant change in appetite.

  4. Sleep disturbances.

  5. Psychomotor changes (either moving slower than usual or being unusually agitated) that are significant enough to be noticed by others.

  6. Low energy, tiredness, or fatigue. May also lose efficiency when working on routine tasks.

  7. A sense of worthlessness or inappropriate guilt.

  8. Difficulty concentrating or diminished ability to make decisions.

  9. Suicidal ideation/suicide attempt or self-harm.**

**If you or someone you love is considering committing suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 for emotional support and resources. If they have made a suicide attempt, please call emergency services immediately. 

In addition to these criteria, the depressive symptoms must last at least two weeks, interfere with daily life and functioning, and cause the individual clinically significant distress. The depressive symptoms must also not be accompanied by manic symptoms, as experienced in a manic or hypomanic episode. Furthermore, these symptoms should not be accompanied by other symptoms that cannot be explained by the presence of schizoaffective disorder or other psychotic disorders. Finally, a diagnosis should exclude symptoms easily explained by another medical condition, illness, or substance misuse.*

*If you or a loved one are struggling with substance misuse, please contact the Substance Abuse And Mental Health Services Administration (SAMHSA) National Helpline at (800)662-4357.

Main Criteria

The DSM-5 identifies several different symptoms of depression, but two main criteria must be considered. These two are depressed mood and anhedonia. A depressed mood has to do with sadness or negative emotions. Anhedonia means that you no longer feel any pleasure or interest in the things you once enjoyed. You must have one or the other of these two main criteria to be diagnosed as depressed.

Secondary Symptoms

If you meet one of the two main criteria (or both), the secondary symptoms will be considered. These include somatic symptoms related to your physical body, as well as non-somatic symptoms that are related to thought and emotion.

Somatic Symptoms

Somatic symptoms of depression are felt in your body as you often experience physical changes while depressed. The following are somatic or body-related symptoms mentioned in the DSM-5 depression criteria:

  • Sleep difficulties – If you’re depressed, you may have insomnia or sleep more than usual. You may have trouble going to sleep or staying asleep. Sometimes people with depression wake up very early and can’t go back to bed. Often, especially in young people with depression, people sleep much more than usual. Excessive sleeping is called hypersomnia.

  • Changes in appetite or weight – While you’re depressed, you may find that you don’t have much of an appetite for any food. Or you might feel like eating constantly. It’s the change in your eating habits that’s significant to the diagnosis. The same can be true for weight gain or loss. You may lose or gain weight when you have depression. What clues your doctor in that you have depression is that these things are changing.

  • Poor concentration – Poor concentration can be common when you’re living with depression because your brain may not be working as well as it usually does. You may have a hard time focusing on your work, daily chores, or even leisure activities like watching a movie or reading a book.

  • Fatigue – The DSM criteria for depression mentions physical fatigue and loss of energy. This includes decreased activity, feeling tired, low energy, decreased endurance, feeling weak, heavy, sluggish, or slow, putting in more effort to do the same physical tasks, or feeling sleepy.

  • Psychomotor agitation or retardation – This criterion has to do with slowing down or speeding up your physical and emotional reactions. In psychomotor retardation, you may find that you think and move very slowly. In psychomotor agitation, you might feel restless, anxious, irritable, and tense. You may have racing thoughts or be unable to sit still.

Non-Somatic Symptoms

The non-somatic symptoms of depression include your emotions and the content of your thoughts. These are the non-somatic symptoms of depression described in the DSM-5:

  • Depressed mood – Depressed mood is about emotion. It’s feeling sad or low.

  • Anhedonia – This is a loss of pleasure, interest, or enjoyment.

  • Feelings of worthlessness or guilt – This symptom of depression is present when you feel there’s no worth or value in yourself as a person. Unwarranted feelings of guilt are also common when you’re depressed.

  • Thoughts of suicide or death – If you think a lot about death or have thoughts of suicide, it’s important to seek help.

If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 and is available 24/7.

Diagnosing Depression With The DSM 5

Mental health professionals go to school for years to understand how to make an accurate diagnosis of a mental illness like depression. This is why it’s important not to try to diagnose yourself or someone else. Knowing the symptoms can help you decide when to seek help, but the professional is responsible for making the diagnosis once you do.

In addition to the list and description of symptoms, the DSM-5 outlines several other criteria for making a diagnosis of depression. The following are some of the guidelines given in the DSM.

Number Of Symptoms

During a consultation and interview, your medical provider will ask you about each of the symptoms outlined in the DSM-5. They note whether you have one of the two main symptoms of depression – depressed mood or anhedonia – and add up each of the secondary symptoms you’re experiencing. If you have five or more total symptoms, the DSM-5 recommends a diagnosis of depression.

Duration And Impact

While assessing your symptoms and deciding whether to count them, your mental health professional notes the duration of your symptoms and considers to what extent they’re affecting your life. To receive a diagnosis of depression, you must experience five or more symptoms most of the day every day during one two-week period. Your medical provider will pay attention to how distressing these symptoms are to you and whether they impair your functioning at work, in social situations, and in other aspects of your life.

Other Causes Of Symptoms

Before you get a diagnosis of depression, your doctor needs to rule out other reasons you might be experiencing certain symptoms Many medical conditions can mimic signs of depression. Your doctor will also need to determine if the symptoms are substance induced. If there’s nothing else causing your symptoms, the diagnosis may be depression.

All Or None Diagnosis

The depression diagnosis the DSM 5 suggests is an all-or-none diagnosis. Each symptom is considered as either present or not present. The criteria don’t specify the severity of the symptoms – only whether it’s present or not. Typically, the severity of the condition could be determined using depression scales like the Hamilton Depression Rating Scale.

However, one study suggested that the symptoms listed in the DSM-5 for depression could be used to determine the severity of the mental disorder. The researchers explained that the somatic symptoms could distinguish moderate depression from non-depression. On the other hand, the non-somatic symptoms are more likely to be prominent in severe depression and can separate moderate and severe depression.

Wondering If You’re Experiencing Symptoms Of Depression?

DSM 5 Depression Code

The DSM-5 is used alongside the International Classification of Diseases (ICD-10), which gives each DSM depression code and codes for other medical conditions. The depression DSM 5 code from the ICD-10 is determined by its severity (mild, moderate, or severe), and status (in remission or having recurrent depressive episodes). Although this is sometimes called the DSM 5 code for depression, the code is actually from the ICD-10.

Additional Specifiers In The DSM V Depression Criteria

In addition to the diagnostic information in previous versions of the DSM, the DSM-5 gives two more specifiers to consider when diagnosing depression. The first new classification is depression “with mixed features.” This specifier notes symptoms of mania within a major depressive episode. The second is “with anxious distress.” This recognizes the presence of anxiety symptoms that occur along with depression.

Does The DSM-5 Recommend Treatments?

The DSM-5 was designed as a handbook for diagnosis and therefore does not recommend any treatments. Medical professionals use this manual solely for determining if someone has a mental illness. They rely on other sources to determine what to do about it.

What To Do If You Think You're Depressed

If you feel you might be depressed, it can be vital to talk to a mental health professional to get an expert diagnosis. Once you have a diagnosis, you can come up with a treatment plan with your therapist or doctor. Treatment can involve medications, psychotherapy, or a combination of therapies.

Online Counseling With BetterHelp

Depression is a serious mental health disorder that may require assistance from a professional. If you’ve been experiencing symptoms of depression and aren’t sure where to turn next, online counseling may be a helpful resource to consider. BetterHelp is an online counseling platform that can connect you with a therapist who has experience with treating cases of depression. Participating in online therapy allows you to receive care from anywhere you have an internet connection, making it particularly convenient when your depression makes it difficult to get out of bed. 

The Efficacy Of Online Counseling

Several different studies have shown the efficacy of online counseling for treating a variety of mental health disorders. One study found that “depression symptom severity was significantly reduced” for those using a multimodal digital therapy platform. These results were consistent regardless of gender, socioeconomic background, or physical health status. Further, those who had never gone to therapy before experienced even more notable results. 

The Takeaway 

There are many different symptoms you might experience if you’re living with depression. Although it can be tempting to diagnose yourself, confiding in a licensed medical provider can ultimately provide you with the most accurate diagnosis of your condition. Once you get a diagnosis and understand what it means, you can begin to take steps to heal. A licensed online therapist can support you on your journey to more positive mental health and equip you with the tools you need to move forward. It is possible to live a full, healthy life despite a diagnosis of depression.  

You Don’t Have To Face Depression Alone. Our Experienced Counselors Can Help.

The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
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