5% of body weight in a month), or decrease or increase in appetite nearly every day# Diagnosis requires exposure to neuroleptics for at least 3 months, but often take longer Insomnia or hypersomnia nearly every day# Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)# Fatigue or loss of energy nearly every day# Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely selfreproach or guilt about being sick)# Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)# Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.B. The symptoms do not meet criteria for a mixed episodeC. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioningD. The symptoms are not due to the direct physiologic effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)E. The symptoms are not better accounted for by bereavement; i.e., after the loss of a loved one, the symptoms persist for 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.Major or Severe endogenous/ melancholic depressionIs characterized by early morning awakening, marked weight loss, psychomotor retardation and/or agitation, diurnal variation, and lack of reactivity. ECT is at least as effective as TCA in the short-term treatment of these severe endogenous/melancholic depressions. ECT appears to be more effective than MAOI in the treatment of severe depressions.Involutional melancholiaIs a syndrome of severe depression and mania which occurs in involutional period (old age). It is characterized by marked agitation, multiple somatic symptoms (somatization), hypochondriacal delusions, and psychotic features like delusions of persecution, tactile and auditory hallucination.">