(biến thể ban ngày với các triệu chứng thường nặng hơn vào buổi sáng, buổi sáng sớm thức tỉnh và sự thèm ăn giảm sút), và động cơ tính năng (đánh dấu chậm phát triển tâm thần vận động, cổ động). Các phân biệt được rút ra trong DSM-IV và phần lớn các báo cáo | Depression 35 Table 1 Symptom Overview for a Major Depressive Episode Domain DSM-IV symptoms Other symptoms Melancholic features Atypical features Emotional 1 Depressed mood 2 Interest pleasure core symptoms at least one must be present Anxiety Irritability Mood not reactive Mood distinct quality Mood reactive Vegetative 1 Weight loss gain 2 Insomnia hypersomnia 3 Fatigue loss of energy ị Libido Weight loss Early morning awakening Diurnal variation morning worse Weight gain Hypersomnia Ideational Cognitive 1 Worthlessness guilt 2 Suicidal ideation Concentration indecisiveness Hopelessness Helplessness text Guilt Rejection sensitivity Motor Psychomotor retardation agitation Retardation agitation Leaden paralysis diurnal variation with symptoms generally worse in the morning early morning awakening and diminished appetite and motor features marked psychomotor retardation or agitation . The distinctions drawn in the DSM-IV and the majority of reports in the literature support the notion that melancholic depression is best viewed as a distinct subtype. Atypical features include mood reactivity capacity to be cheered up when presented with positive events increased appetite or weight gain hypersomnia leaden paralysis a feeling of heaviness in the limbs and a long-standing pattern of extreme sensitivity to perceived interpersonal rejection. There is some evidence to suggest that these depressive subtypes may have different underlying causes and more clearly differential responses to treatment. Dysthymia is characterized by a chronically depressed mood that occurs for most of the day more days than not for at least 2 years. In children the mood may be irritable rather than depressed and the required minimum duration is only 1 year. During periods of depressed mood patients must have at least two of the following symptoms present poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or difficulty making decisions and .
