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What are the DSM 5 diagnostic criteria for depressive disorder due to another medical condition?
- A. A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture.
- B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
- C. The disturbance is not better explained by another mental disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition).
- D. The disturbance does not occur exclusively during the course of a delirium.
- E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specifiers (if desired):
- With depressive features: Full criteria for a major depressive episode are not met.
- With major depressive-like episode: Full criteria for a major depressive episode are met (except the cause is medical).
- With mixed features: Includes manic or hypomanic symptoms that do not meet criteria for a manic/hypomanic episode.
Examples of Medical Conditions That May Cause Depression
- Neurological: Stroke, Parkinson’s disease, Huntington’s disease, traumatic brain injury, multiple sclerosis, epilepsy
- Endocrine: Hypothyroidism, Cushing’s syndrome
- Infectious: HIV/AIDS, hepatitis
- Autoimmune: Lupus (SLE)
- Metabolic: Vitamin B12 deficiency
- Neoplastic: Brain tumors
- Cardiovascular: Myocardial infarction, heart failure
Clinical Tip
- Diagnosis requires establishing a causal link between the medical condition and depressive symptoms—not just co-occurrence.
- Tools like temporal correlation, symptom onset, and resolution with medical treatment help determine causality.
Latest Developments in DSM-5 Diagnostic Criteria for Depressive Disorder Due to Another Medical Condition
The DSM-5 criteria for Depressive Disorder Due to Another Medical Condition (code F06.31) remain largely unchanged since the initial DSM-5 publication. The DSM-5-TR updates through September 2025 did not introduce substantive revisions to these criteria; most changes have focused on other diagnostic categories and coding clarifications.
Current DSM-5-TR Diagnostic Criteria
Criterion A
– A prominent and persistent depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.
Criterion B
– Evidence from history, physical examination, or laboratory findings that the mood disturbance is the direct pathophysiological consequence of another medical condition.
Criterion C
– The disturbance is not better explained by another mental disorder (e.g., major depressive disorder, bipolar disorder).
Criterion D
– The mood disturbance does not occur exclusively during the course of a delirium.
Criterion E
– The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Coding and Specifiers
– Primary Code: F06.31 (Depressive Disorder Due to Another Medical Condition) must be preceded by an additional code for the etiological medical condition (e.g., E03.9 for hypothyroidism).
– Specifier “With Depressed Mood” or “With Anxious Distress” may be applied to characterize prominent features of the syndrome.
Clinical and Research Considerations
- Temporal Relationship
– A clear temporal link is required between onset or exacerbation of the medical condition and the mood disturbance, distinguishing it from primary depressive disorders. - Differential Diagnosis
– Exclusion of delirium is crucial; if depressive symptoms occur only within delirium, F06.31 is not appropriate.
– Substance/Medication-Induced Depressive Disorder (F15.4–F19.4) must be ruled out when medications or toxins may contribute to mood symptoms. - No DSM-5-TR Revisions
– The September 2024 and September 2025 DSM-5-TR supplements did not modify the core criteria for Depressive Disorder Due to Another Medical Condition.
– Ongoing discussion in the field centers on dimensional measurement of symptom severity and incorporation of biomarkers to strengthen the pathophysiological link, but formal DSM updates are pending future editions. - Clinical Utility
– Accurate diagnosis ensures appropriate treatment: targeting the underlying medical condition often ameliorates mood symptoms, and adjunctive antidepressant therapy can be considered based on severity and patient context.
Depressive Disorder Due to Another Medical Condition is a mood disorder diagnosis where there is a prominent and persistent period of depressed mood or markedly diminished interest/pleasure thought to be related to the direct physiological effects of another medical condition.
Major depression, as well as other depressive disorders, is commonly comorbid with other medical illnesses, particularly chronic and systemic medical illnesses. The co-occurrence of the disorders is so common that it challenges our notions of the meaning of comorbidity and our desire to neatly separate psychiatric and medical illnesses.
The overlap between symptoms of physical illness and the neurovegetative symptoms of major depression and the initial normative emotional response to physical illness add to the challenge of accurate diagnosis and timely treatment of depression in the medically ill. We review the literature on the comorbidity of depression and the various medical illnesses, including diagnostic and treatment approaches.
The differential diagnosis for major depression among medically ill patients should include delirium and medication-induced symptoms. We suggest that major depression itself may be best conceptualized as a systemic illness whose pathophysiology overlaps with other systemic medical illnesses.
The initial treatment strategies for major depression in medical illness are like those for the general population; however, the comorbid medical illnesses may interfere with remission.
Sources
Thom R, Silbersweig DA, Boland RJ. Major Depressive Disorder in Medical Illness: A Review of Assessment, Prevalence, and Treatment Options. Psychosom Med. 2019 Apr;81(3):246-255. doi: 10.1097/PSY.0000000000000678. PMID: 30720699. https://pubmed.ncbi.nlm.nih.gov/30720699/
