| Condition | Distinguishing features |
| Patients with prominent depressive symptoms |
| Major depressive disorder* | - Meets criteria for ≥5 of 9 depressive symptoms, at least 1 of which is dysphoria or anhedonia
- Present for at least 2 consecutive weeks nearly every day and causes significant distress or impaired functioning
- Not caused by a substance or other medical condition, and symptoms are not clearly consistent with normal response to a significant loss
- No history of mania or hypomania
|
| Persistent depressive disorder* | - Dysphoria and at least 2 other symptoms (eg, appetite change, sleep disturbance, low energy, low self-esteem, impaired concentration, hopelessness)
- Symptoms occur on most days for at least 2 consecutive years
- Generally fewer symptoms than major depressive disorder
- Symptom-free periods do not exceed 2 consecutive months
|
| Substance/medication-induced depressive disorder* | - Characterized by persistently depressed/irritable mood or anhedonia that causes significant distress or impaired functioning
- Develops during or soon after substance/medication use
- Did not precede the exposure and does not persist long after cessation of exposure
- Does not occur solely in context of delirium
|
| Depressive disorder due to another medical condition* | - Characterized by persistently depressed/irritable mood or anhedonia that causes significant distress or impaired functioning
- Onset generally during first month of the medical condition onset
- Did not clearly precede the medical condition onset and does not occur solely in context of delirium
- Associated medical conditions include adrenal insufficiency, Huntington's disease, hypercortisolism, hypothyroidism, mononucleosis, multiple sclerosis, obstructive sleep apnea, Parkinson disease, stroke, systemic lupus erythematosus, traumatic brain injury, and vitamin B12 deficiency
- Suspect when depression has not responded to other treatment attempts
|
| Premenstrual dysphoric disorder* | - Meets criteria for ≥5 depressive symptoms, at least 1 of which is mood swings, irritability, sense of hopelessness, depressed mood, anxiety
- Symptoms repeatedly occur in the week before menses onset and remit with menses onset of a few days later
|
| Bipolar disorder | - Mood episodes include mania or hypomania in addition to major depression
|
| Adjustment disorder with depressed mood | - Symptoms do not meet criteria for a specific depressive disorder (eg, major depressive disorder)
- Symptoms occur in response to identifiable psychosocial stressor and resolve within 6 months of stressor
|
| Patients without prominent depressive symptoms |
| Sadness Burnout Acute grief Prolonged grief disorder | - Symptoms do not meet criteria for depressive disorder, eg:
- Dysphoria without other associated depressive symptoms
- Symptoms not present on most days
- In burnout, predominant symptoms of emotional exhaustion and depersonalization
- In acute grief and prolonged grief disorder, predominant symptoms of longing for and preoccupation with the deceased
|
| Attention deficit hyperactivity disorder | - Impaired concentration and inattention are long-standing and pervasive (do not only occur in context of active mood episodes)
- Sleep or appetite disturbances and suicidality generally not present
|
| Borderline personality disorder | - Can include dysphoria and suicidality, but mood states fluctuate throughout the day
- Can include identity disturbance, frantic efforts to avoid abandonment, and chronic feelings of emptiness, which are not features of major depression
- Sleep or appetite disturbances and low energy generally not present
|
| Delirium | - Distinguished from depressive disorders by:
- Decreased level of alertness and consciousness
- Significant impairment of other neurocognitive functions
- Marked fluctuations in symptoms
|
| Dementia | - Depression may precede the onset of dementia or develop as a complication of dementia syndromes
- In depression, the patient's subjective complaints of memory loss are often disproportionate to objective findings of cognitive dysfunction
|
| Schizophrenia and schizoaffective disorder | - Delusions and hallucinations occur outside the context of an episode of major depression
|
