- Poor appetite or overeating
- Sleeping too much or too little
- Lower energy or fatigue
- Low self-esteem
- Difficulty with focus or concentrating
- Feelings of hopelessness
During the one-year period, the youth has never been without the depressive symptoms. Criteria for a major depressive disorder may be continuously present for two years, and there has never been a manic episode. The disturbance is not better explained by other psychotic disorders, and the symptoms are not attributable to the physiological effects of a substance. The symptoms cause clinically significant distress or impairment in overall functioning.