DSM-IV* Symptoms of major depressive syndrome and substitute symptoms recommended by Endicott

Symptom*	Substitute•
Δ Depressed mood most of the day
Δ Markedly diminished interest or pleasure in all, or almost all, activities most of the day
Weight loss or gain (eg, more than 5% of body weight in a month) or decrease or increase in appetite	Depressed appearance
Insomnia or hypersomnia	Social withdrawal or decreased talkativeness
Psychomotor agitation or retardation
Fatigue or loss of energy	Brooding, self-pity, or pessimism
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness	Lack of reactivity; cannot be cheered up
Recurrent thoughts of death, or suicidal ideation or planning, or a suicide attempt

One of the symptoms marked by a delta (Δ) must be present for a diagnosis of major depressive syndrome. Each symptom must also meet severity (eg, "most of the day, nearly every day" and duration (greater than 2 weeks) criteria. Finally, the symptoms must be judged to cause clinically significant distress or impairment; they must not be due to the direct physiological effects of a medication or general medial condition; and they must not be better accounted for by bereavement.

* DSM-IV, Amer Psych Assoc, 1994. Diagnostic and statistical manual, 4th ed (DSM-IV).
• Endicott, J. Cancer 1984; 53:2243.

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DSM-IV* Symptoms of major depressive syndrome and substitute symptoms recommended by Endicott