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F33.1·CIM-10-CM

Major Depressive Disorder, Recurrent, Moderate

Recurrent depressive disorder with a current episode meeting full DSM-5-TR criteria for major depressive episode at moderate severity.

Outil de dépistage recommandé

Outil de dépistage validé
Patient Health Questionnaire-9 (PHQ-9)
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DSM-5-TR diagnostic criteria summary

A diagnosis of Major Depressive Disorder, Recurrent (F33.x) requires:

  • At least one prior major depressive episode separated from the current episode by at least 2 consecutive months without meeting full criteria.
  • A current major depressive episode: five or more of nine symptoms during the same 2-week period (depressed mood, anhedonia, weight/appetite change, sleep change, psychomotor change, fatigue, worthlessness/guilt, concentration difficulty, or thoughts of death). At least one symptom must be depressed mood or anhedonia.
  • Clinically significant distress or impairment in social, occupational, or other functioning.
  • No history of a manic or hypomanic episode.
  • Not better explained by a substance, medication, another medical condition, or another psychotic/depressive disorder.

The fifth digit specifies severity: F33.0 mild, F33.1 moderate, F33.2 severe, F33.3 with psychotic features, F33.40/F33.41/F33.42 in remission.

Source: American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), p. 183–192.

Differential diagnosis

  • Persistent Depressive Disorder (F34.1, dysthymia), chronic depressed mood for ≥2 years; can co-occur with MDD ("double depression").
  • Bipolar I/II (F31.x), current depressive episode with prior mania or hypomania; coding selection differs significantly.
  • Adjustment Disorder with Depressed Mood (F43.21), depressive symptoms in response to an identifiable stressor, not meeting full MDE criteria.
  • Substance/Medication-Induced Depressive Disorder.
  • Depressive Disorder Due to Another Medical Condition (F06.31, F06.32), hypothyroidism, stroke, Parkinson's, etc.
  • Bereavement: DSM-5-TR removed the bereavement exclusion; clinical judgment is required when grief presents alongside MDE criteria.

Common comorbidities

Common co-occurring conditions: Generalized Anxiety Disorder (F41.1), Panic Disorder (F41.0), PTSD (F43.10), Substance Use Disorders (F10–F19), and chronic medical conditions (cardiovascular disease, diabetes, chronic pain). Routinely co-administer GAD-7 with PHQ-9 in primary care and behavioral health workflows, see the PHQ-9 vs GAD-7 comparison for choosing between scales when symptoms overlap.

Sources

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F33.1, p. 183–192.
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
  • Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines.

Foire aux questions

What is ICD-11 code F33.1?

F33.1 is the ICD-11-CM code for Major Depressive Disorder, Recurrent Episode, Moderate. It denotes a recurrent depressive disorder where the current episode meets full DSM-5-TR criteria for major depressive episode at moderate severity.

What are the diagnostic criteria for F33.1?

DSM-5-TR criteria require five or more depression symptoms during the same 2-week period (with at least one being depressed mood or anhedonia), causing clinically significant distress or impairment, with a history of at least one prior major depressive episode and no history of mania or hypomania. F33.1 specifically denotes moderate severity (between F33.0 mild and F33.2 severe).

What scale is used to screen for F33.1?

The Patient Health Questionnaire-9 (PHQ-9) is the standard screener. A PHQ-9 score of 10 or higher has 88% sensitivity and 88% specificity for major depression (Kroenke et al., 2001). Scores of 10–14 typically align with moderate severity (F33.1), 15–19 with moderately severe, and 20–27 with severe (F33.2).

What is the difference between F33.1 and F32.1?

F32.1 codes a single (first) major depressive episode of moderate severity; F33.1 codes a recurrent depressive disorder where a current episode of moderate severity is occurring. The distinction matters for prognosis, treatment selection, and reporting.

Is F33.1 the same as the ICD-11 code for depression?

F33.1 is one of several ICD-11 codes for depression. The major depression code family includes F32.0–F32.5 (single episode by severity) and F33.0–F33.4 (recurrent by severity, plus 'in full remission'). F33.1 specifically denotes recurrent moderate depression.

Is F33.1 a billable ICD-11-CM code?

Yes, F33.1 is a billable ICD-11-CM code as of the 2025 official tabular list. It is the standard reimbursed code for a recurrent moderate-severity major depressive episode. Other billable F33 severity codes include F33.0 (mild), F33.2 (severe without psychotic features), F33.3 (severe with psychotic features), F33.40 (in remission, unspecified), F33.41 (in partial remission), and F33.42 (in full remission).

What are the symptoms of recurrent major depression?

Recurrent major depression produces the same symptom cluster as a single episode, but with at least one prior depressive episode in lifetime. Core symptoms include persistent low mood, loss of interest or pleasure, fatigue, sleep disturbance, and appetite or weight changes lasting at least two weeks. Cognitive symptoms include worthlessness, guilt, concentration difficulty, and thoughts of death or suicide. At least five of nine symptoms must be present, including either low mood or anhedonia.

How is recurrent depression diagnosed?

Recurrent major depressive disorder is diagnosed by a clinician using DSM-5-TR criteria, which require a current major depressive episode plus at least one prior episode separated by at least two months of remission. Diagnosis typically follows a positive PHQ-9 screen, structured clinical interview, longitudinal mood history, and bipolar screening to rule out F31.x. Severity of the current episode determines the fifth digit (F33.0 mild, F33.1 moderate, F33.2 severe).

What causes recurrent depression?

Recurrent depression arises from a combination of genetic, neurobiological, and psychosocial factors. Heritability estimates from twin studies range from 30% to 40%, and recurrent presentations show stronger family-history loading than single-episode depression. Neurobiological contributors include serotonin and HPA axis dysregulation, reduced hippocampal volume, and inflammatory markers. Risk of recurrence increases with each prior episode and is amplified by chronic stress, untreated comorbidity, and incomplete remission.

How long does recurrent depression last?

Recurrent major depressive disorder is typically a lifelong condition with episodic course rather than continuous illness. Individual episodes average 6 to 8 months untreated and 2 to 4 months with evidence-based treatment. Risk of another episode is around 50% after one prior episode, 70% after two, and 90% after three. Maintenance antidepressant therapy and structured psychotherapy reduce recurrence risk and prolong remission.

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