SIG E CAPS
Major Depressive Disorder Criteria (DSM-5)
5 of 9 symptoms for 2+ weeks — the DSM-5 depression shorthand.
Memory aids matter when a vignette describes a patient who's been off for a few weeks and the differential separates major depression from grief, adjustment disorder, and a medical cause. SIG E CAPS captures the eight neurovegetative DSM-5 symptoms — Sleep changes, Interest loss, Guilt, Energy decreased, Concentration impaired, Appetite changes, Psychomotor agitation or retardation, Suicidality — and pairs them with depressed mood as the ninth. Five of nine symptoms (one of which must be depressed mood or anhedonia) lasting two weeks or more meets criteria. AANP boards tests the count, the duration, and the requirement that anhedonia or low mood anchor the picture.
- SSleep changesInsomnia or hypersomnia — ask about both.
- IInterest loss (anhedonia)One of the two required core symptoms (with depressed mood).
- GGuilt / worthlessnessExcessive or inappropriate; not just about being sick.
- EEnergy lossFatigue nearly every day.
- CConcentration impairmentOr indecisiveness.
- AAppetite / weight changeSignificant change up or down (>5% body weight in a month).
- PPsychomotor agitation or retardationObservable by others, not just subjective.
- SSuicidalityRecurrent thoughts of death, suicidal ideation, plan, or attempt. Always ask directly.
Clinical Context
Diagnose MDD when ≥5 symptoms are present for at least 2 weeks, and one must be depressed mood OR anhedonia. Symptoms must cause functional impairment and not be attributable to substance use or another condition.
The AANP often gives a stem with 3-4 symptoms and asks whether criteria are met. Count carefully, check duration, and screen for bipolar before prescribing an SSRI — antidepressants can trigger mania in unrecognized bipolar disorder.
Related Mnemonics
Sources
Ready to practice?
1,500+ AANP-style questions with rationales — free trial.