Moreover, the symptoms must occur nearly every day, for at least 0 consecutive weeks, except for thoughts of death and suicidal ideation, which must be recurrent, and attempting suicide or making a specific plan, which only needs to occur once.
The episode must be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning.
For some individuals with milder episodes, functioning may appear to be normal but requires markedly increased effort.
The presenting complaint is often insomnia or fatigue rather than depressed mood or loss of interest; thus, the failure to probe for accompanying depressive symptoms can result in underdiagnosis.
Fatigue and sleep disturbance are present in a high proportion of cases; psychomotor disturbances are much less common but are indicative of greater overall severity, as is the presence of delusional or near-delusional guilt.