F32.1·ICD-10-CM

Major Depressive Disorder, Single Episode, Moderate

A first major depressive episode of moderate severity meeting DSM-5-TR criteria, with no prior documented depressive episodes.

Recommended screener

Validated screener
Patient Health Questionnaire-9 (PHQ-9)
View scale

DSM-5-TR diagnostic criteria summary

F32.1 requires a single major depressive episode meeting the following criteria:

  • Five or more of the following symptoms during the same 2-week period, representing a change from prior functioning. At least one must be (a) or (b):
  • (a) Depressed mood most of the day, nearly every day
    • (b) Markedly diminished interest or pleasure (anhedonia)
    • Significant weight loss/gain or appetite change
    • Insomnia or hypersomnia
    • Psychomotor agitation or retardation
    • Fatigue or loss of energy
    • Feelings of worthlessness or excessive guilt
    • Diminished concentration or indecisiveness
    • Recurrent thoughts of death or suicidal ideation
    • Not attributable to a substance or another medical condition.
    • Not better explained by a psychotic disorder.
    • No history of mania or hypomania.

    The fourth digit specifies severity: F32.0 mild, F32.1 moderate, F32.2 severe, F32.3 with psychotic features, F32.4/F32.5 in remission, F32.81 premenstrual dysphoric disorder, F32.89 other, F32.9 unspecified.

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

    Differential diagnosis

    • F33.1 MDD, Recurrent, Moderate, at least one prior MDE; same severity, different course specifier.
    • F31.x Bipolar I/II Disorder, when prior mania or hypomania is identified, recode to bipolar; routine MDQ screening before antidepressant initiation reduces misdiagnosis.
    • F34.1 Persistent Depressive Disorder (dysthymia), chronic depressed mood ≥2 years, may co-occur with MDE ("double depression").
    • F43.21 Adjustment Disorder with Depressed Mood, depressive symptoms in response to identifiable stressor, not meeting full MDE criteria.
    • Substance/Medication-Induced Depressive Disorder, F06.31/F06.32 Depressive Disorder Due to Another Medical Condition.

    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. Routine co-administration of GAD-7 with PHQ-9 in primary care is standard.

    Sources

    • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F32.1, 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.

    Frequently asked questions

    What is ICD-11 code F32.1?

    F32.1 is the ICD-11-CM code for Major Depressive Disorder, Single Episode, Moderate. It is used when a patient has experienced a single major depressive episode of moderate severity meeting full DSM-5-TR criteria, with no prior depressive episodes documented.

    What are the diagnostic criteria for F32.1?

    DSM-5-TR major depressive episode requires 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, thoughts of death). At least one symptom must be depressed mood or anhedonia. Symptoms must cause clinically significant distress or impairment, not be substance-induced or due to another condition, and there must be no history of mania or hypomania.

    What scale is used to screen for F32.1?

    The Patient Health Questionnaire-9 (PHQ-9) is the standard screener. PHQ-9 scores of 10–14 typically align with moderate severity (F32.1 single episode or F33.1 recurrent), 15–19 with moderately severe, and 20–27 with severe. Item 9 (suicidal ideation) requires immediate clinical follow-up if endorsed at any level.

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

    F32.1 codes a single (first) major depressive episode of moderate severity, the patient has no documented prior depressive episodes. F33.1 codes a recurrent depressive disorder where a current episode of moderate severity is occurring, at least one prior MDE in lifetime. The distinction affects prognosis, treatment selection, and duration of maintenance therapy.

    When does an F32 single episode become an F33 recurrent disorder?

    When a second major depressive episode occurs after at least 2 consecutive months without meeting full criteria. At that point the diagnosis transitions from F32.x (Single Episode) to F33.x (Recurrent), and the severity specifier of the current episode determines the fifth digit (F33.0 mild, F33.1 moderate, F33.2 severe, etc.).

    Is F32.1 a billable ICD-11-CM code?

    Yes, F32.1 is a billable ICD-11-CM code as of the 2025 official tabular list. It is the standard reimbursed code for a single moderate-severity major depressive episode. Other billable F32 severity codes include F32.0 (mild), F32.2 (severe without psychotic features), F32.3 (severe with psychotic features), F32.4 (in partial remission), and F32.5 (in full remission).

    What are the symptoms of major depressive disorder?

    Major depressive disorder produces a cluster of mood, cognitive, and physical symptoms lasting at least two weeks. Core symptoms include persistent low mood, loss of interest or pleasure, fatigue, sleep disturbance (insomnia or hypersomnia), and appetite or weight changes. Cognitive symptoms include worthlessness, excessive guilt, concentration difficulty, and recurrent thoughts of death or suicide. At least five of nine symptoms must be present and at least one must be low mood or loss of interest.

    How is major depressive disorder diagnosed?

    Major depressive disorder is diagnosed by a clinician using DSM-5-TR criteria, which require at least 5 of 9 symptoms during the same 2-week period, with at least one being depressed mood or anhedonia. Diagnosis typically follows a positive PHQ-9 screen (score 10 or higher), structured clinical interview, ruling out medical and substance-induced causes, and bipolar screening. Severity is graded mild, moderate, or severe based on symptom count and functional impact.

    What causes major depressive disorder?

    Major depressive disorder arises from a combination of genetic, neurobiological, and psychosocial factors. Heritability estimates from twin studies range from 30% to 40%. Neurobiological contributors include serotonin, norepinephrine, and dopamine signaling differences, HPA axis dysregulation, and reduced hippocampal volume. Psychosocial triggers include early-life adversity, chronic stress, recent losses, medical illness, and lack of social support.

    Can major depressive disorder be cured?

    A first major depressive episode is a treatable condition that often resolves with appropriate care. First-line treatments include cognitive behavioral therapy, interpersonal therapy, behavioral activation, and antidepressant medication (SSRIs or SNRIs); roughly 50% to 70% of patients achieve remission within 6 to 12 weeks of evidence-based treatment. Risk of recurrence is around 50% after one episode and rises with each subsequent episode, which is why ongoing monitoring matters.

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