(1) The patient has three or four of the following symptoms for at least 2 weeks, one of which must be (a) or (b) |
(a) Depressed mood most of the day, almost every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful) |
(b) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, almost every day |
(c) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 % of body weight in 1 month), or decrease or increase in appetite almost every day |
(d) Insomnia or hypersomnia almost every day |
(e) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) |
(f) Fatigue or loss of energy nearly every day |
(g) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) |
(h) Diminished ability to think or concentrate, or indecisiveness, almost every day (either by subjective account or as observed by others) |
(i) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide |
(2) The symptoms in (1) are accompanied by two (or more) of the following symptoms of anxious distress, also lasting at least 2 weeks: |
(a) Irrational worry |
(b) Preoccupation with unpleasant worries |
(c) Having trouble relaxing |
(d) Motor tension |
(e) Fear that something awful would happen |
(3) No other DSM diagnosis of anxiety or depression is present |