8
2. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
3. The episode is not attributable to the physiological effects of a
substance or to another medical condition.
Note: Criteria 1–3 represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from
a natural disaster, a serious medical illness or disability) may include the feelings
of intense sadness, rumination about the loss, insomnia, poor appetite, and weight
loss noted in Criterion A, which may resemble a depressive episode. Although such
symptoms may be understandable or considered appropriate to the loss, the presence
of a major depressive episode in addition to the normal response to a significant loss
should also be carefully considered. This decision inevitably requires the exercise of
clinical judgment based on the individual's history and the cultural norms for the
expression of distress in the context of loss.
4. The occurrence of the major depressive episode is not
better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified and
unspecified schizophrenia spectrum and other psychotic disorders.
5. There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or
hypomanic-like episodes are substance-induced or are attributable
to the physiological effects of another medical condition.
