What Are The DSM 5 Depression Criteria?

It can be natural to experience occasional sadness. However, not everyone who experiences sadness receives a diagnosis of depression. For this reason, some people may wonder how a medical professional determines whether someone is living with the condition. The answer lies in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5. 

The DSM-5 lays out the criteria for clinical depression explicitly, and mental health professionals use it to diagnose mental illness. To understand depression, it can be helpful to know what depression is and how it is diagnosed. 

DSM 5 criteria for depression

The DSM-5 definition of depression is more than a one-sentence description. Instead, it's a detailed and comprehensive explanation of symptoms indicating a depressive disorder. 

To understand depression, it can be essential to know that depression is an umbrella term for multiple depressive disorders. However, in this article, it is used to describe major depressive disorder (MDD), the most common depressive disorder listed in the DSM-5. 

Other depressive disorders not examined below include the following: 

• Disruptive mood dysregulation disorder

• Persistent depressive disorder (dysthymia)

• Premenstrual dysphoric disorder

• Substance or medication-induced depressive disorder

• Depressive disorder due to another condition

• Other specified depressive disorder

• Unspecified depressive disorder

• Post-partum depression (PPD) 

• Seasonal affective disorder (SAD) 

Note that the above depressive disorders have unique criteria in the DSM-5 and may not present similarly to major depressive disorder. 

What are the DSM-5 criteria for major depressive disorder (MDD)? 

Major depressive disorder is a serious mood disorder affecting millions worldwide. The official criteria for MDD can be found in the Diagnostic and Statistical Manual created by the American Psychiatric Association (APA). 

To make a diagnosis, a professional looks for at least five of the following diagnostic criteria occurring for at least two weeks every day: 

• A depressed mood

• Loss of interest or pleasure in previously enjoyed activities 

• Significant weight loss or gain 

• Sleep disturbances

• Psychomotor changes, such as moving slower than usual or agitation 

• Low energy, tiredness, or fatigue

• A sense of worthlessness or inappropriate guilt

• Difficulty concentrating or a diminished ability to make decisions

• Suicidal ideation or urges 

In addition to the above 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. 

When making a diagnosis, a doctor may check that symptoms are not accompanied by other symptoms that the presence of schizoaffective disorder or other psychotic disorders cannot explain. Finally, a diagnosis should exclude symptoms easily explained by another medical condition, illness, or substance misuse.

Main criteria

The DSM-5 identifies several symptoms of depression, but two primary criteria must be considered. The most essential symptoms in the diagnosis are a depressed mood and anhedonia. A depressed mood involves sadness or a sense of profound dread. 

Anhedonia involves a loss of pleasure or interest in what you once enjoyed or were able to do. Some people with depression may struggle to work, practice hygiene, or get out of bed due to anhedonia. 

Secondary symptoms will be considered if you meet one of the two main criteria. These include somatic symptoms related to your physical body, as well as non-somatic symptoms that are related to thought and emotion.

What are somatic symptoms? 

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

Sleep difficulties 

If you're living with depression, you may have insomnia or sleep more than usual. You may also have trouble falling or staying asleep. Some people with depression may wake up early and stay awake in bed. Young people with depression may be more likely to sleep more than usual, called hypersomnia.

Changes in appetite or weight  

When experiencing depression, you may not have an appetite for food. Conversely, you may eat more than usual or binge on foods due to stress. The same can be true for weight gain or loss. You may lose or gain weight when you have depression due to these eating habits or internal bodily processes. 

Poor concentration  

Poor concentration can be common when living with depression due to sleep changes, difficulty caring for yourself, and other routine differences. You may struggle to focus on your work, daily chores, or leisure activities like watching a movie or reading a book.

Fatigue 

The DSM criteria for depression mention physical fatigue and loss of energy. Fatigue can include decreased activity, tiredness, low energy, decreased endurance, physical weakness, heaviness, sluggishness, or slowed movement. It can also mean putting more energy than usual into tasks. 

Psychomotor agitation or slowness 

This criterion concerns slowing down or speeding up your physical and emotional reactions. In psychomotor slowness, you may think and move slowly. You might become restless, anxious, irritable, and tense in psychomotor agitation. You may have racing thoughts or struggle to sit still. 

Non-somatic symptoms

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

• A depressed mood

• Anhedonia 

• Thoughts of worthlessness or hopelessness

• Guilt 

• Suicidal ideation or thoughts of death

Diagnosing depression using 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. For this reason, it can be essential not to try to diagnose yourself or someone else. Knowing the symptoms can help you decide when to seek help. However, the professional is responsible for an official diagnosis. 

In addition to the list of symptoms, the DSM-5 outlines several criteria for mental health professionals to note before diagnosing depression, including the following. 

Number of symptoms

During a consultation and interview, your mental health professional may ask you about each of the symptoms outlined in the DSM-5. They may note whether you have the two prominent symptoms of depression: depressed mood or anhedonia. In addition, they may add each of the secondary symptoms you're experiencing. If you have five or more total symptoms, the DSM-5 recommends a diagnosis of depression. However, your therapist may consider other symptoms, as well. 

Duration and impact

While assessing your symptoms, 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 a two-week period. Your medical provider may 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 provider may rule out other reasons you might be experiencing specific symptoms. A medical condition can sometimes mimic signs of depression. In addition, substance use can cause some depression symptoms. If substance use is prompting depression, you may be instead diagnosed with substance or medication-induced depressive disorder. 

All or none diagnosis

The depression diagnosis the DSM 5 suggests is an all-or-none diagnosis. Each symptom is considered present or not present. The criteria don't specify the severity of the symptoms. However, the severity of the condition may be determined using depression scales like the Hamilton Depression Rating Scale.

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 specifier recognizes the presence of anxiety symptoms that occur alongside depression.

What is the DSM-5 depression code for providers? 

The DSM-5 is used alongside the International Classification of Diseases (ICD-10), which gives codes therapists and providers can use to bill insurance companies for treatment. 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). The session length may also determine the code. There are no codes for billing in the DSM-5. 

Depression support options 

If you believe you might be experiencing depression, you're not alone. You can contact an in-person therapist or doctor to discuss your diagnosis options. However, Not everyone has the opportunity to connect with a licensed therapist without a diagnosis if you're looking for immediate support. 

Depression is a serious mental health condition often requiring long-term support and treatment. Online therapy platforms like BetterHelp can connect you with a therapist with experience treating cases of depression. Participating in online therapy allows you to receive care from anywhere with an internet connection, which may be convenient if you struggle to leave your bed. 

Several studies have proven the effectiveness of online counseling in treating various mental health conditions. One study found that "depression symptom severity was significantly reduced" after clients used a multimodal digital therapy platform. These results were consistent regardless of gender, socioeconomic background, or physical health status. Further, those who had never been to therapy experienced more notable results.