Table 4.

DSM-IV criteria for major depressive disorder and reasons for further psychiatric evaluation

Major Depression	Indications for Further Psychiatric Evaluation
At least one of these must be present:	Evidence of suicidal ideation, inability to care   for self or dependent others, or   aggressivity/homicidal ideation
Depressed mood
Loss of interest or pleasure in most or all     activities
Four or more of the following must be   present:	Failure to respond to or is intolerant of initial   treatment trial
Insomnia or hypersomnia	Patient or clinician interested in modalities   requiring specialty expertise   (psychotherapy or electroconvulsive   therapy, transcranial magnetic   stimulation)
Change in appetite or weight
Psychomotor retardation or agitation
Low energy
Poor concentration
Thoughts of worthlessness or guilt	Psychotic symptoms present
Recurrent thoughts about death or suicide	History of bipolar disorder or psychotic   disorder
	Significant psychiatric comorbidity (anxiety   disorders, substance use, cognitive   disorder)
	Unclear diagnosis of depression