... large portions of the day, lethargy, fatigue or loss of energy. Feelings of worthlessness are a primary symptom of depression along with excessive or inappropriate guilt, diminished ability to think or concentrate, indecisiveness, and in significant cases, recurrent thoughts of death or suicide. There are also further diagnostic guidelines included in DSM IV; these are that the condition is not a mixed episode occurring at the same time as a manic episode, also that symptoms cause significant distress or impairment of functioning, though the degree of impairment necessary is not defined. The condition is not due to substance abuse or a medical condition, and that the depression is not better explained by bereavement, because this reflects the 'normal' grieving process and not a psychiatric disorder, also that the symptoms the patient presents could not be better explained by another diagnosis. Finally, DSM IV states that the major depressive episode should ...

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