- Depressed mood most of the day, nearly every day as characterized by feeling sad, empty or hopeless. In youth, this may present as primarily irritability.
- Low – or no – interest in activities that were previously enjoyable.
- Significant weight loss or gain when not actively trying to change weight – or significant changes in appetite (up or down).
- Insomnia (not able to fall or stay asleep) or hypersomnia (sleeping too much) nearly every day.
- Changes in activity – either very agitated and fidgety – or reduced/slowed movement – to the extent that other people notice.
- Fatigue or very low energy nearly every day.
- Feelings or worthlessness or excessive guilt.
- Diminished ability to concentrate or trouble making decisions that was not previously present.
- Recurrent thoughts about death or dying, including thoughts or plans about one’s own death.
These symptoms must cause impairment in function – with one’s family, friends, or at school – and, as mentioned above, they must represent a change in functioning. Some youth may be naturally fidgety or have trouble concentrating, if these symptoms existed prior to the depressed mood, caution must be taken in attributing them to the depressive episode. Related, it is natural for a child or adolescent to experience symptoms of depression following a significant loss (e.g., death of a family member) and bereavement must be considered first when these symptoms present within the context of a loss. Finally, depressive symptoms may also occur within the context of a bipolar spectrum disorder, if a youth becomes depressed after first experiencing a period during which his/her mood was abnormally elevated and s/he had high energy, it is possible that s/he is experiencing an episode of bipolar depression.