Table 1. DSM-IV criteria 1. For major depressive episode A. Five(or more) of the following symptoms have been present during the same 2-week period an

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2 Table 1. DSM-IV criteria 1. For major depressive episode A. Five(or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure. (Do not include symptoms that are clearly due to physical condition, mood-incongruent delusions or hallucinations.) 1) Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others. 2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation by made by others). 3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. 4) Insomnia or hypersomnia nearly every day. 5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 6) Fatigue or loss of energy nearly every day. 7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely selfreproach or guilt about being sick). 8) Diminished ability to think or concentrate, or indecisiveness, nearly every day(either by subjective account or as observed by others). 9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide. B. The symptoms do not meet criteria for a mixed episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance. (eg, a drug of abuse, a medication) or a general medical condition (e.g, hypothyroidism). E. The symptoms are not better accounted for by bereavement, ie, after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlesseness, suicidal ideation, psychotic symptoms, or psychomotor retardation. 2. For major depression, single episode A. Presence of a single major depressive episode. B. The major depressive episode is not better accounted for by schizoaffective disorder, and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. C. There has never been a manic episode, a mixed episode, or a hypomanic episode. 3. For major depression, recurrent A. Presence of two or more major episodes. B. The major depressive episodes are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizopreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. C. There has never been a manic episode, a mixed episode, or a hypomanic episode. J Kor Neurol Ass / Volume 19 / Sup 1,

3 Table 2. ICD-10 criteria Depressive episode G1. The depressive episode should last for at least 2 weeks G2. There have been no hypomanic or manic symptoms sufficient to meet the criteria for hypomanic or manic episode at any time in the individual s life. G3. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder. Mild depressive episode A. The general criteria for depressive episde must be met. B. At least two of the following three symptoms must be present: 1) depressed mood to a degree that is definitely abnormal for the individual, present for most of the day and almost every day, largely uninfluenced by circumstances, and sustained for at least 2 weeks; 2) loss of interest or pleasure in activities that are normally pleasurable; 3) decreased energy or increased fatiguability. C. An additional symptom or symptoms from the following list should be present, to give a total of at least four: 1) loss of confidence or self-esteem; 2) unreasonable feelings or self-reproach or excessive and inappropriate guilt; 3) recurrent thoughts of death or suicide, or any suicidal behavior; 4) complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation; 5) change in psychomotor activity, with agitation or retardation (either subjective or objective); 6) sleep disturbance of any type; 7) change in appetite (decrease or increase) with correponding weight change. Moderate depressive episode A. The general criteria for depressive episode must be met. B. At least two of the three symptoms listed for criterion B above must be present. C. Additional symptoms from depressive episode, criterion C, must be present, to give a total of at least six. Severe depressive episode without psychotic symptoms A. The general criteria for depressive episode must be met. B. All three of the symptoms in criterion B, depressive episode must be present. C. Additional symptoms from depressive episode, criterion C, must be present, to give a total of at least eight. D. There must be no hallucinations, delusions, or depressive stupor. Severe depressive episode with psychotic symptoms A. The general criteria for depressive episode must be met. B. The criteria for severe depressive episode without psychotic symptoms must be met with the exception of criterion D C. The criteria for schizophrenia or schizoaffective disorder, depressive type, are not met. D. Either of the following must be present: 1) delusions or hallucinations, other than those listed as typically schizophrenic in criterion 2) depressive stupor 68 J Kor Neurol Ass / Volume 19 / Sup 1, 2001

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10 Boston, Havard University Press, American Psychiatric Association. Practice Guidelines. Washington DC, American Psychiatric Association, American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, World Health Organization, Klerman GL, Weissman MM. The course, morbidity, and costs of depression. Arch Gen Psychiatry ; 4 9 : Keller MB, Beardslee WR, Dorer DJ, Lavori PW, Samuelson H, Klerman GR. Impact of severity and chronicity of parental affective illness on adaptive functioning and psychopathology in children. Arch Gen Psychiatry 1986;43: Mintz J, Mintz LI, Arruda MJ, Hwang SS. Treatments of depression and the functional capacity to work. Arch Gen Psychiatry 1992;49: Regier DA, Boyd JH, Burke JD Jr, Rae DS, Myers JK, Kramer M, Robins LN, George LK, Karno M, Locke BZ. One-month prevalence of mental disorders in the United States: based on five Epidemiologic Catchment Area sites. Arch Gen Psychiatry 1988;45: Akiskal HS. The clinical management of affective disorders, In: Michels R, Cooper AM, Guze SB, Judd LL, Klerman GL, Solnit AJ. P s y c h i a t r y, vol 1. Philadelphia, Lippincott, Jacobson E. Contribution to the metapsychology of cyclothymic depression, In: Greenacre P. A f f e c t i v e D i s o r d e r s. New York, International Universities Press, Jacobson E. D e p r e s s i o n. New York, International Universities Press, Jacobson E. The Self and the Object World. New York, International Universities Press, Klerman GL, Weissman MM, Rounsaville BJ, Chevron ES. Interpersonal Psychotherapy of Depression. New York, Basic Books, Lewinsohn PM, Antonuccio DA, Steinmetz-Breckinridge J, Teri L. The Coping With Depression Course: A Psychoeducational Intervention for Unipolar Depression. Eugene, Castalia Publishing, Brown RA, Lewinsohn PM. A psychoeducational approach to the treatment of depression: comparison of group, individual, and minimal contact procedures. J Consult Clin Psychol 1990;52: Beck AT, Rush AJ, Shaw BF, Emery G. C o g n i t i v e Therapy of Depression. New York, Guilford Press, Beach SRH, Sandeen EE, O Leary KD. Depression in Marriage. New York, Guilford Press, Murray GI, Lopez AL. The global burden of disease. 18. Yager J. Patients with mood disorders and marital/family J Kor Neurol Ass / Volume 19 / Sup 1,

11 problems, In: Tasman A. Annual Review of Psychiatry, vol 11. Washington, DC, American Psychiatric Press, Coyne JC. Assessment and Treatment, In : Clarkin JF, Haas GL, Glick ID. Affective Disorders and the Family. New York, Guilford Press, Jacobson NS, Dobson K, Fruzzetti AE, Schmaling KB, Salusky S. Marital therapy as a treatment for depression. J Consult Clin Psychol 1991;59: Katz MM, Koslow SH, Maas JW, Frazer A, Bowden CL, Casper R, Croughan J, Kocsis J, Redmond E Jr. The timing, specificity and clinical prediction of tricyclic drug effects in depression. Psychol Med 1987;17: Quitkin FM, Rabkin JG, Markowitz JM, Stewart JW, McGrath PJ, Harrison W:Use of pattern analysis to identify true drug response. Arch Gen Psychiatry 1987;44: Johnston JA, Lineberry CG, Ascher JA, Davidson J, Khayrallah MA, Feighner JP, Stark P. A 102-center prospective study of seizure in association with bupropion. J Clin Psychiatry 1991;52: Preskorn SH, Jerkovich GS. Central nervous system toxicity of tricyclic antidepressants: phenomenology, course, risk factors, and role of therapeutic drug monitoring. J Clin Psychopharmacol 1990;10: Bigger JT, Giardina EG, Perel JM, Kantor SJ, Glassman AH. Cardiac antiarrhythmic effect of imipramine hydrochloride. N Engl J Med 1977;296: Giardina EG, Barnard T, Johnson L, Saroff AL, Bigger JT Jr, Louie M. The antiarrhythmic effect of nortriptyline in cardiac patients with ventricular premature depolarizations. J Am Coll Cardiol 1986;7: Schwartz P, Wolf S. QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation 1978;57: Glassman AH, Johnson LL, Giardina EG, Walsh BT, Roose SP, Cooper TB, Bigger JT Jr. The use of imipramine in depressed patients with congestive heart failure. JAMA 1983;250: Armitage R, Yonkers K, Cole D. A multicenter, double blind comparison of the effects of nefazodone and fluoxetine on sleep architecture and quality of sleep in depressed outpatients. J Clin Psychopharmacol 1997;17: Goodwin M. How do antidepressants affect serotonin receptors? J Clin Psychiatry 1996;57(suppl 4): Feiger A, Kiev A. Nefazodone vs sertraline in outpatients with major depression: focus on efficacy, tolerability and effects on sexual function and satisfaction. J Clin Psychiatry 1996;57(suppl 2: 53-62). 32. Clerc GE, Ruimy P, Verdeau-palles J. A double-blind comparison of venlafaxine and fluoxetine in patients hospitalized for major depression and melancholia. The venlafaxine French Inpatient study group. Int Clin Psychopharmacol 1994;9: Derivan A, Entsuah AR, Kikta D. Venlafaxine: measuring the antidepressant action. Psychopharmacol Bull 1995;31: Deboer T. The Pharmacologic profile of mirtazapine. J Clin Psychiatry 1996;57(suppl 4): Frazer A. Pharmacology of antidepressant. J Clin Psychopharmacol 1997;17:2S-18S. 36. Spilder HA, Ramoska EA, Krenzelok EP. Bupropion overdose: A 3-year multicenter retrospective analysis. Am J Emerg Med 1994;12: Mass JW. Biogenic amine & depression. Arch Gen Psychiatry 1975;32: Staner L, Bertolino A, Cassano GB. European multicenter study of tianeptine vs imipramine and placebo in the treatment of major depression and depressive bipolar disorders. Eur Psychiatry 1994;9(suppl 1):140S. 39. Alby JM, Ferreri J, Cabane C, de Bodinat, Dagens V. Efficacy of tianeptine vs fluoxetine in the treatment of major depression and dysthymia with somatic complaints. Ann Psychiatr 1993;8(2): American Psychiatric Association. Task Force on Electroconvulsive Therapy: The Practice of Electroconvulsive Therapy. Washington, DC, APA, Rosenthal NE, Sack DA, Carpenter CJ, Parry BL, Mendelson WB, Wehr TA. Antidepressant effects of light in seasonal affective disorder. Am J Psychiatry 1985;142: Vanselow W, Dennerstein L, Armstrong S, Lockie P. Retinopathy and bright light therapy (letter). Am J Psychiatry 1991;148: Mood Disorders. Pharmacologic Prevention of Recurrences. Natl Inst Health Consensus Dev Conf Consensus Statement 1984;5(4). 44. Guscott R, Grof P. The clinical meaning of refractory depression: a review for the clinician. Am J Psychiatry 1991;148: Marcus ER, Bradley SS. Combination of psychotherapy and psychopharma -cotherapy with treatment-resistant inpatients with dual diagnoses. Psych Clin N Am 1990;13: Price LH, Charney DS, Heninger GR. Variability of response to lithium augmentation in refractory depression. Am J Psychiatry 1986;143: Wharton RN, Perel JM, Dayton PG, Malitz S. A potential clinical use for methylphenidate with tricyclic antidepressants. Am J Psychiatry 1971;127: Feighner JP, Herbstein J, Damlouji N. Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression. J Clin Psychiatry 1985;46: Nelson JC, Mazure CM, Bowers MB Jr, Jatlow PI. A preliminary, open study of the combination of fluoxetine and desipramine for rapid treatment of major depression. Arch Gen Psychiatry 1991;48: Rosenstein DL, Takeshita J, Nelson JC. Fluoxetine- 76 J Kor Neurol Ass / Volume 19 / Sup 1, 2001

12 induced elevation and prolongation of tricyclic levels in overdose (letter). Am J Psychiatry 1991;148: Prudic J, Sackheim HA. Refractory depression and electroconvulsive therapy, In : Roose SP, Glassman AH. Washington, DC, Treatment Strategies for Refractory Depression. American Psychiatric Press, Penney JF, Dinwiddie SH, Zorumski CF, Wetzel RD. Concurrent and close temporal administration of lithium and ECT. Convulsive Therapy 1990;6: Cullen M, Mitchell P, Brodaty H, Boyce P, Parker G, Hickie I, Wilhelm K. Carbamazepine for treatmentresistant melancholia. J Clin Psychiatry 1991;52: Hayes SG. Long-term use of valproate in primary psychiatric disorders. J Clin Psychiatry ; 5 0 ( 3 suppl): Zisook S, Shuchter SR. Depression through the first year after the death of a spouse. Am J Psychiatry ; : Robinson RG, Starkstein SE. Current research in affective disorders following stroke. J Neuropsychiatry Clin Neurosci 1990;2:1-14. J Kor Neurol Ass / Volume 19 / Sup 1,

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