• Loss of interest in daily activities
• Sadness, emptiness, or feeling down
• Hopelessness
• Tiredness and lack of energy
• Low self-esteem, self-criticism, or feeling incapable
• Trouble concentrating and trouble making decisions
• Irritability or excessive anger
• Decreased activity, effectiveness, and productivity
• Avoidance of social activities
• Feelings of guilt and worries over the past
• Poor appetite or overeating
• Sleep problems

Criterion A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. In children and adolescents, mood can be irritable and duration must be at least 1 year.

Criterion B. The presence of two or more of the following, while depressed:

1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness

Criterion C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in criteria A and B for more than 2 months at a time.

Criterion D. Criteria for a major depressive disorder may be continuously present for 2 years.

Criterion E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.

Criterion F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Criterion G. The symptoms are not attributed to the physiological effects of a substance or another medical condition.

Criterion H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Feature specifiers:

• With anxious distress
• With mixed features
• With melancholic features
• With atypical features
• With mood congruent-psychotic features
• With peripartum onset

Episode specifiers:

• With pure dysthymic syndrome
• With persistent major depressive episode
• With intermittent major depressive episodes, with current episode
• With intermittent major depressive episodes, without current episode

Onset specifier:

• Early onset (onset before age 21)
• Late onset (onset at or after age 21)

Severity specifier:

• Mild
• Moderate
• Severe

Remission specifier:

• In partial remission
• In full remission