Major depressive disorder in DSM-5-TR and ICD-11
The DSM-5-TR is the US clinical manual. The ICD-11, published by the World Health Organization, is used across most of the world for both clinical and administrative coding. Both describe depression, but the criteria differ enough that a clinician using one may not match a clinician using the other on the same patient. This is what actually differs.
DSM-5-TR Major depressive disorder ICD-10-CM F32.x (single episode), F33.x (recurrent)
ICD-11 Depressive disorder, single episode 6A70, 6A71
Side by side
| What | DSM-5-TR | ICD-11 |
|---|---|---|
| Number of symptoms required ICD-11 structures the required symptoms into three domains rather than one flat list. | 5 or more of 9 listed symptoms. | At least 5 symptoms from 3 clusters (affective, cognitive-behavioral, neurovegetative). Total count matters more than which cluster. |
| Required core symptom ICD-11 splits interest and pleasure into two features; DSM-5-TR treats anhedonia as one criterion. | At least one of the 5 must be depressed mood OR loss of interest/pleasure (anhedonia). | At least one required affective symptom: depressed mood, reduced interest, or reduced ability to feel pleasure. |
| Duration Practically identical. | Present most of the day, nearly every day, for at least 2 weeks. | Present most of the day for at least 2 weeks, though a single day of full remission does not restart the count. |
| Functional impairment Broader wording in ICD-11 but the same requirement in practice. | Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas. | Significant difficulty in personal, family, social, educational, occupational, or other important areas. |
| Exclusion of medical or substance cause | Symptoms not attributable to a substance or another medical condition. | Same. Also excludes depressive symptoms better accounted for by another condition (bipolar, grief expected in the person's culture). |
| Bereavement exclusion Different. Clinicians in DSM-5-TR practice are asked to distinguish grief from depression clinically without a formal exclusion. | Removed in DSM-5 (2013). A person meeting criteria within days of a loss can be diagnosed. | Distinguishes depressive episode from prolonged grief disorder. Cultural expectations of grief are considered. |
| Severity specifiers Both use similar severity brackets. DSM-5-TR has more granular specifiers. | Mild, moderate, severe, with psychotic features. Also atypical, melancholic, catatonic, mixed features, anxious distress, seasonal pattern, peripartum onset. | Mild, moderate, severe without psychotic symptoms, severe with psychotic symptoms. Specifiers for melancholic, seasonal pattern, and perinatal onset are separate. |
| Recurrent classification This is a real structural difference. | Same diagnosis with a 'recurrent' specifier. In the US the ICD-10-CM code moves from F32.x (single episode) to F33.x (recurrent). | Separate code: Recurrent depressive disorder (6A71). Recurrent depression is treated as a distinct disorder in ICD-11 rather than a specifier. |
Key differences
- ICD-11 treats recurrent depression as a distinct disorder (6A71). DSM-5-TR handles it as a specifier on major depressive disorder.
- ICD-11 groups symptoms into three clusters (affective, cognitive-behavioral, neurovegetative) with at least one affective symptom required. DSM-5-TR uses one flat symptom list with at least one of two core symptoms required.
- DSM-5-TR removed the bereavement exclusion in 2013. ICD-11 still expects clinicians to distinguish depression from culturally expected grief responses and from prolonged grief disorder.
- DSM-5-TR has more granular specifiers (atypical, mixed features, anxious distress) than ICD-11.
- Both agree on 2-week duration, 5-symptom threshold, and impairment requirement. Threshold is aligned even if wording differs.
Clinical implications
- Cross-system agreement is high in typical cases. Studies comparing the two find that most people meeting DSM-5-TR criteria also meet ICD-11 criteria for the equivalent condition and vice versa.
- Disagreement is more likely in atypical presentations, in recent bereavement, or when the depressive episode has prominent mixed features.
- For international research, both systems are usually reported. For US clinical practice, DSM-5-TR is standard. For US administrative coding, ICD-10-CM is still used, and ICD-11 is being phased in.
- When two clinicians using different systems disagree on a diagnosis, checking which specific criterion is not met usually resolves it quickly.
## Why this crosswalk exists
Most depression content on the internet uses DSM-5-TR language without saying so. That works in the US. It confuses clinicians and patients everywhere else. This page lays out both systems side by side, in plain language, using the current published criteria. If you have received a depression diagnosis in one system and want to understand what it would be called in the other, this is the crosswalk.
## Sources
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Section on Depressive Disorders. 2022.
- World Health Organization. International Classification of Diseases 11th Revision (ICD-11). Chapter 6, Mental, behavioural or neurodevelopmental disorders, 6A70 Single episode depressive disorder. 2022.
- Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3-19.
- First MB, Gaebel W, Maj M, et al. An organization-and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry. 2021;20(1):34-51.