tion of an irreve rsible dementia.
Thoughts of death, suicidal ideation, or suicide attempts (Cri terion A9) are common.
They may range from a passive wish not to aw aken in the morning or a belief that others
would be better off if the individual were dead , to transient but recurrent thoughts of com-
mitting suicide, to a specific suicide plan. Mo re severely suicidal individuals may have put
their affairs in order (e.g., up dated wills, settled debts), acqu ired needed materials (e.g., a
rope or a gun), and chosen a location and time  to accomplish the suicide. Motivations for
suicide may include a desire to give up in th e face of perceived insurmountable obstacles,
an intense wish to end what is perceived as an unending and excruciatingly painful emo-
tional state, an inability to fo resee any enjoyment in life, or the wish to not be a burden to
others. The resolution of such thinking may be a more meaningful measure of diminished
suicide risk than denial of further plans for suicide.
The evaluation of the symptoms of a major depressive episode is especially difficult
when they occur in an indivi dual who also has a general me dical condition (e.g., cancer,
stroke, myocardial infarction, diabetes, pregna ncy). Some of the criterion signs and symp-
toms of a major depressive episode are iden tical to those of general medical conditions
(e.g., weight loss with untreated diabetes; fatigue with cancer; hypersomnia early in preg-
nancy; insomnia later in pregnancy or the postpartum). Such symp toms count toward a
major depressive diagnosis except when they are clearly and fully attributable to a general
medical condition. Nonv egetative symptoms of dysphoria,  anhedonia, guilt or worthless-