Document ID: chunk:federal_register_of_legislation:F2024L00045:reg:7:p4
Version: federal_register_of_legislation:F2024L00045
Segment Type: reg
Provision Reference: reg 7 (pt 4/5)
Character Range: 10509–13785

(ii)         the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or
(iii)       there is other evidence suggesting the existence of an independent non-substance/medication-induced depressive disorder (e.g., a history of recurrent non-substance/medication-related episodes).
(d)          The disturbance does not occur exclusively during the course of a delirium.
(e)          The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(8)          premenstrual dysphoric disorder meets the following criteria (derived from DSM-5-TR):
(a)          In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
(b)          One (or more) of the following symptoms must be present:
(i)            Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).
(ii)         Marked irritability or anger or increased interpersonal conflicts.
(iii)       Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
(iv)        Marked anxiety, tension, and/or feelings of being keyed up or on edge.
(c)          One (or more) of the following symptoms must additionally be present, to reach a total of 5 symptoms when combined with symptoms from Criterion (b) above.
(i)            Decreased interest in usual activities (e.g., work, school, friends, hobbies).
(ii)         Subjective difficulty in concentration.
(iii)       Lethargy, easy fatigability, or marked lack of energy.
(iv)        Marked change in appetite; overeating; or specific food cravings.
(v)          Hypersomnia or insomnia.
(vi)        A sense of being overwhelmed or out of control.
(vii)     Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of "bloating," or weight gain.
Note: The symptoms in Criteria a–c must have been met for most menstrual cycles that occurred in the preceding year.
(d)          The symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).
(e)          The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder, or a personality disorder (although it may co-occur with any of these disorders).
(f)           Criterion (a) should be confirmed by prospective daily ratings during at least two symptomatic cycles.
(g)          The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).
(9)          other specified depressive disorder and unspecified depressive disorder have prominent symptoms of depression that cause clinically significant distress or impairment in social, occupational or other important areas of