The diagnosis of Major Depressive Disorder (MDD) relies on identifying a specific pattern of symptoms over a defined period. To help clinicians and health professionals recall these diagnostic criteria, the mnemonic SIGECAPS is widely used in psychiatry. This device provides a quick way to remember the common behavioral, emotional, and physical changes associated with a major depressive episode. SIGECAPS acts as a checklist, ensuring standardized criteria for depression are systematically considered during patient assessment.
Deciphering the SIGECAPS Mnemonic
The eight letters of SIGECAPS each represent a specific symptom that may be present during a major depressive episode.
The first “S” stands for Sleep disturbance, which can manifest as insomnia (difficulty sleeping) or hypersomnia (sleeping significantly more than usual) nearly every day. This change must represent a noticeable shift from a person’s prior habits.
The letter “I” signifies Interest loss, also known as anhedonia, where an individual experiences diminished pleasure or interest in nearly all activities they previously enjoyed. “G” represents Guilt, involving feelings of worthlessness or excessive and inappropriate guilt that occurs nearly every day. This is a deep-seated sense of personal inadequacy.
“E” is for Energy loss, commonly described as persistent fatigue or a noticeable decrease in energy. Tasks require much greater effort than before. The letter “C” stands for Concentration difficulties, including problems with thinking, focusing attention, or decision-making. This cognitive slowing can significantly impair performance.
The letter “A” refers to Appetite changes, which can be a significant decrease leading to weight loss, or an increase resulting in weight gain. A change of more than five percent of body weight in a month is often considered significant. The letter “P” is for Psychomotor changes, which must be observable by others. This includes psychomotor retardation (slowing of movement and speech) or psychomotor agitation (purposeless, restless activity).
The final “S” represents Suicidal ideation, encompassing recurrent thoughts of death, thinking about suicide, or a specific plan or attempt at suicide. The presence of this symptom is a serious concern that requires immediate attention.
The Diagnostic Framework
The symptoms recalled by the SIGECAPS mnemonic form the basis of the official diagnostic criteria for a Major Depressive Episode, established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To receive a diagnosis, a person must exhibit five or more of the nine potential symptoms during the same two-week period. These symptoms must represent a clear change from the person’s previous level of functioning.
A diagnosis requires that at least one of the five symptoms be either depressed mood or the loss of interest or pleasure (anhedonia). This rule ensures the core emotional experience of depression is present for identification. Furthermore, the symptoms must be present nearly every day for the entire two-week duration, with the exception of weight change and suicidal ideation.
The symptoms must also be severe enough to cause clinically significant distress or impairment in important areas of functioning, such as social life or occupational performance. The symptoms cannot be directly attributable to the physiological effects of a substance, such as drug abuse, or another underlying medical condition.