Melancholic Features Specifier for Mood Disorders

Specify if: With Melancholic Features (can be applied to the current or most recent Major Depressive Episode in Major Depressive Disorder and to a Major Depressive Episode in Bipolar I or Bipolar II Disorder only if it is the most recent type of mood episode) 

A. Either of the following, occurring during the most severe period of the current episode: 

(1) loss of pleasure in all, or almost all, activities 
(2) lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens) 

B. Three (or more) of the following: 

(1) distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one) 
(2) depression regularly worse in the morning 
(3) early morning awakening (at least 2 hours before usual time of awakening) 
(4) marked psychomotor retardation or agitation
(5) significant anorexia or weight loss 
(6) excessive or inappropriate guilt

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association