Version July 2025
This algorithm should be used in conjunction with UpToDate topics on clinical symptoms, evaluation, and diagnosis of depression. This algorithm outlines the diagnostic approach to the adult with a likely depressive disorder and is intended to guide the user to the most likely possible diagnosis.
Definitive diagnosis requires a comprehensive evaluation and confirmation via diagnostic interview, particularly since patients may meet criteria for multiple psychiatric and general medical disorders.
For an overall approach to the patient with suspected depression, refer to UpToDate topics on the approach to the adult patient with suspected depression.
Orange boxes are depressive disorders other than MDD. Blue boxes are MDD or subtypes of MDD. Refer to UpToDate topics on clinical features and diagnosis of depression in adults for details.DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision; MDD: major depressive disorder; PHQ-9: 9-item Patient Health Questionnaire; WHO: World Health Organization.
* Individuals who require urgent evaluation include those at imminent risk of self-harm or harming others and those with life-threatening functional impairment, acute mania, or psychosis. Refer to UpToDate topics on the approach to the adult patient with suspected depression for details on the assessment of features that require urgent evaluation.
¶ To assess for clinical symptoms of depression, clinicians can use structured instruments (eg, PHQ-9) and/or direct questioning about symptoms. We typically use diagnostic criteria from the DSM-5-TR or the WHO's International Classification of Diseases. Refer to UpToDate topics on the clinical features and diagnosis of depression in adults for details.
Δ Individuals with an acute psychosocial stressor who meet diagnostic criteria for MDD have that diagnosis, not adjustment disorder.
◊ Coincidental onset of depressive symptoms with the medical condition or medication is necessary, but not sufficient, to establish this diagnosis. Clinicians should additionally use clinical judgement to determine if the timing and types of depressive symptoms suggest that the new-onset medical condition, new medication, or alcohol or drug use is causing the depressive symptoms.
§ After establishing the diagnosis of MDD, clinicians should evaluate for depression subtypes that may affect prognosis and/or treatment (eg, anxious, catatonic, mixed, and psychotic). Refer to UpToDate topics on the clinical features and diagnosis of depression in adults for details.