In pediatric depression, irritability can be a presenting symptom. Which statement accurately reflects DSM-5-TR criteria?

• A. Irritability in youth automatically rules out MDD.
• B. It may meet criteria if five symptoms including irritability and distress or impairment are present over two weeks.
• C. It negates MDD.
• D. Irritability is not considered in DSM-5 criteria.

Answer: (B)

Pediatric Major Depressive Disorder can present with irritability, and the DSM-5-TR criteria allow that irritability to count toward the symptom checklist. The diagnosis requires five or more symptoms occurring during the same two-week period, representing a change from previous functioning, with clinically significant distress or impairment. In youth, irritability can substitute for a depressed mood as one of those symptoms. So it is possible to meet criteria if there are five symptoms including irritability, with distress or impairment, over a two-week span. Irritability does not rule out MDD and is indeed recognized as a valid symptom in younger patients.