These criteria have been criticized. For example, Boyd et al. commented on the requirement that decline be present for a diagnosis of depression, offering an anecdotal case of an elderly woman with virtually no social life, living in isolation, who appeared depressed but did not meet the criteria because her low role performance could not be shown to have declined (11). Alternative criteria were proposed in the Research Diagnostic Criteria (RDC) for major depressive disorder (12). These require the following criteria to be present: dysphoric mood or pervasive loss of interest that lasted at least one week and for which assistance was sought, plus at least five from a list of symptoms that include disturbed sleep, poor appetite, loss of energy, loss of interest, psychomotor agitation or retardation, feelings of self-reproach, diminished ability to concentrate, and thoughts of suicide (13, Table 2). extra effort.