5. Significant anorexia or weight loss.
6. Excessive or inappropriate guilt.
Note:  The specifier “with melancholic features” is applied if these features are present
at the most severe stage of the episode. There is a near-complete absence of the ca-
pacity for pleasure, not merely a diminution. A guideline for evaluating the lack of reac-
tivity of mood is that even highly desired events are not associated with marked
brightening of mood. Either mood does not bri ghten at all, or it brightens only partially
(e.g., up to 20%–40% of normal for only minutes at a time). The “distinct quality” of mood
that is characteristic of the “with melancholic features” specifier is experienced as qual-
itatively different from that during a nonm elancholic depressive episode. A depressed
mood that is described as merely more severe, longer lasting, or present without a rea-
son is not considered distinct in quality. Psychomotor changes are nearly always pres-
ent and are observable by others.
Melancholic features exhibit only a modest tendency to repeat across episodes in the
same individual. They are more frequent in inpatients, as opposed to outpatients; are
less likely to occur in milder than in more severe major depressive episodes; and are
more likely to occur in those with psychotic features.
With atypical features:  This specifier can be applied when these features predomi-
nate during the majority of days of the current or most recent major depressive episode
or persistent depressive disorder. 
A. Mood reactivity (i.e., mood brightens in response to actual or potential positive
events).