DSM-IV symptoms of major depressive disorder and Endicott substitute symptoms (Endicott criteria)
| DSM-IV symptoms | Endicott substitute symptoms |
| Depressed mood most of the day* | |
| Marked diminished interest or pleasure in all, or almost all, activities most of the day (Anhedonia)* | |
| Weight loss or gain (>5% body weight in a month)/change 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 |
| Feeling of worthlessness or excessive or inappropriate guilt | |
| Diminished ability to think or concentrate, indecisiveness | Lack of reactivity; cannot be cheered up |
| Recurrent thoughts of death, or suicidal ideation or planning, or a suicide attempt |
*One of these symptoms must be present for a diagnosis of major depressive disorder. Each symptom must also meet severity criteria of ‘most of the day’ or ‘nearly every day” with a duration of greater than 2 weeks. The symptoms must cause clinically significant distress or impairment. They are not due to a physiological effect of a medication or general medical condition, and must not be accounted for bereavement.