SIGECAPS: the depression mnemonic and what it leaves out

In this article▾

1. What does SIGECAPS stand for?
2. The SIGECAPS depression mnemonic, explained
3. The symptom SIGECAPS leaves out: depressed mood
4. How many SIGECAPS symptoms are needed for depression?
5. SIGECAPS vs. DSM-5: They are not the same thing
6. SIGECAPS vs. PHQ-9
7. Example: Using SIGECAPS during a clinical interview
8. How to document SIGECAPS
9. Common SIGECAPS mistakes
10. SIGECAPS quick reference
11. Frequently asked questions about SIGECAPS
12. Final takeaway
13. Sources

SIGECAPS is a commonly used mnemonic for remembering the symptoms assessed when evaluating a major depressive episode.

The mnemonic stands for:

• S = Sleep disturbance
• I = Interest or pleasure
• G = Guilt or worthlessness
• E = Energy
• C = Concentration
• A = Appetite or weight change
• P = Psychomotor changes
• S = Suicidal thoughts or behaviors

SIGECAPS is useful for organizing a clinical interview, but it should not be treated as a substitute for the DSM-5 diagnostic criteria. One important limitation is easy to miss: SIGECAPS has eight letters, while DSM-5 lists nine symptom domains for a major depressive episode. Depressed mood is not explicitly represented by the mnemonic.

For a DSM-5 major depressive episode, five or more symptoms must be present during the same two-week period, represent a change from previous functioning, and at least one must be either depressed mood or markedly diminished interest or pleasure. The American Psychiatric Association states the duration requirement as symptoms occurring most of the day, nearly every day, for more than two weeks, together with a clear change in day-to-day functioning.

Sources: American Psychiatric Association: what is depression?

That makes SIGECAPS a memory aid, not a diagnostic checklist.

What does SIGECAPS stand for?

The nine DSM-5 symptom domains also include depressed mood, which SIGECAPS does not have a dedicated letter for.

Clinicians should therefore use SIGECAPS as a prompt to make sure the symptom domains are explored, while separately assessing depressed mood.

The SIGECAPS depression mnemonic, explained

S: Sleep

S = Sleep disturbance.

The DSM-5 criterion includes insomnia or hypersomnia occurring nearly every day.

Ask about changes from the patient's usual sleep pattern rather than simply asking whether they "sleep well."

Useful questions include:

• "How many hours are you sleeping now compared with usual?"
• "Are you having trouble falling or staying asleep?"
• "Are you waking earlier than usual?"
• "Are you sleeping substantially more than usual?"

Both decreased and increased sleep can be relevant.

I: Interest

I = Interest or pleasure.

This corresponds to markedly diminished interest or pleasure in activities.

Clinicians often refer to this as anhedonia.

The key is to assess whether there has been a meaningful change in the patient's ability to enjoy or engage in activities that previously mattered to them.

For example:

"I still go out with my friends, but I don't really enjoy being there anymore."

That is clinically different from simply being busy or having fewer opportunities for recreation.

G: Guilt

G = Guilt or worthlessness.

The DSM-5 criterion includes feelings of worthlessness or excessive or inappropriate guilt.

The clinician should distinguish clinically significant guilt from ordinary regret or appropriate concern about something the patient has done.

Questions might include:

• "How do you feel about yourself lately?"
• "Have you been feeling worthless or like a burden?"
• "Are you blaming yourself for things that are outside your control?"
• "How strong are those thoughts, and how often do they occur?"

E: Energy

E = Energy.

This represents fatigue or loss of energy.

Patients may describe:

• Feeling exhausted despite adequate sleep
• Difficulty getting started in the morning
• Reduced physical stamina
• Feeling mentally drained
• Needing substantially more effort to complete ordinary tasks

As with the other criteria, the clinician should establish whether the symptom represents a change from previous functioning.

C: Concentration

C = Concentration.

The DSM-5 criterion includes diminished ability to think or concentrate or indecisiveness.

Patients may report:

• Difficulty reading
• Losing track of conversations
• Trouble making routine decisions
• Forgetfulness
• Difficulty completing work
• Feeling mentally slowed or "foggy"

Collateral observations can also be clinically useful when appropriate.

A: Appetite

A = Appetite or weight change.

This criterion includes a significant weight change when not dieting, or a meaningful decrease or increase in appetite.

The DSM-5 criterion includes weight change of more than approximately 5% of body weight in a month as an example of significant weight change.

The symptom is broader than simply "poor appetite." Increased appetite and weight gain can also be relevant.

Clinicians should document the actual change rather than simply checking "A = yes."

For example:

"Appetite decreased substantially over the past three weeks, with approximately 8-lb unintentional weight loss."

P: Psychomotor

P = Psychomotor agitation or retardation.

This criterion concerns observable changes in psychomotor activity.

Psychomotor agitation can appear as:

• Pacing
• Restlessness
• Inability to sit still
• Repetitive movements

Psychomotor retardation may appear as:

• Noticeably slowed movement
• Slowed speech
• Long response latency
• Reduced spontaneous activity

The DSM-5 criterion refers to changes severe enough to be observable by others, not a subjective feeling of restlessness or of being slowed down. That is the item most often over-endorsed on self-report measures, which is one reason a PHQ-9 score and a clinical observation can diverge on it.

S: Suicide

S = Suicidal thoughts or behaviors.

The final S represents the suicidality criterion, including recurrent thoughts of death, suicidal ideation, suicide attempts, or a specific suicide plan.

This should not be treated as a checkbox at the end of a mnemonic.

If a patient endorses suicidal thoughts, conduct an appropriate suicide-risk assessment and document the findings: risk and protective factors, intent, plan, access to means where clinically relevant, and the disposition or safety planning that followed. The same applies to item 9 on the PHQ-9, which asks the same question in self-report form and is equally not a risk assessment on its own.

The symptom SIGECAPS leaves out: depressed mood

This is the most important limitation of the mnemonic.

There is no letter in SIGECAPS for depressed mood.

The DSM-5 major depressive episode criteria include nine symptom domains:

1. Depressed mood
2. Diminished interest or pleasure
3. Appetite or weight change
4. Sleep disturbance
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Worthlessness or excessive/inappropriate guilt
8. Diminished concentration or indecisiveness
9. Thoughts of death or suicidal ideation/behavior

SIGECAPS captures the other eight.

This matters because depressed mood and loss of interest are the two gateway symptoms in the DSM-5 criteria. At least one must be present for a major depressive episode.

A clinician who runs through SIGECAPS without separately asking about mood could therefore miss one of the required gateway symptoms.

A practical approach is:

Start with mood and interest, then use SIGECAPS to work through the remaining symptom domains.

How many SIGECAPS symptoms are needed for depression?

The commonly remembered rule is five symptoms for two weeks, but there is an important qualification.

For a major depressive episode, the DSM-5 requires:

• Five or more symptoms
• Present during the same two-week period
• Representing a change from previous functioning
• With at least one symptom being depressed mood or diminished interest/pleasure
• Causing clinically significant distress or impairment
• Not better explained by a substance, medication, or another medical condition
• And with no history of a manic or hypomanic episode that would change the diagnostic formulation.

So the shorthand is:

5+ symptoms + 2 weeks + depressed mood or anhedonia + impairment + appropriate differential assessment

The number five is necessary but not sufficient.

Example

A patient reports:

• Depressed mood nearly every day
• Loss of interest in usual activities
• Insomnia
• Fatigue
• Difficulty concentrating
• Excessive guilt

That is six symptom domains, including both depressed mood and diminished interest.

If the symptoms have been present during the same two-week period, represent a change from baseline, cause clinically significant impairment or distress, and the remaining diagnostic criteria are satisfied, the symptom count supports further consideration of a major depressive episode.

By contrast, a patient with five symptoms lasting only several days does not satisfy the two-week duration criterion for a major depressive episode.

SIGECAPS vs. DSM-5: They are not the same thing

SIGECAPS is a mnemonic.

DSM-5 provides diagnostic criteria.

That distinction is important in clinical documentation.

A clinician can use SIGECAPS during an assessment and still needs to document the broader diagnostic reasoning.

SIGECAPS vs. PHQ-9

SIGECAPS and the PHQ-9 are related but serve different purposes.

SIGECAPS is a clinical mnemonic. It helps a clinician remember which depressive symptom areas to ask about. If you want a framework for the history itself rather than the symptom list, OLDCARTS covers onset, duration, timing and severity.

PHQ-9 is a standardized self-report instrument. It asks patients to rate nine depressive symptoms based on the preceding two weeks and produces a quantitative score.

The PHQ-9 can be useful for screening and monitoring symptom severity. It does not replace a diagnostic evaluation.

This distinction is particularly useful when documenting depression:

SIGECAPS: What symptoms did the clinician assess?

PHQ-9: What did the standardized symptom measure show?

DSM-5: Does the overall clinical presentation meet diagnostic criteria?

For a practical guide to administering, scoring and documenting the PHQ-9, see our PHQ-9 scoring guide. For the manic and hypomanic side of the same history, see DIGFAST, which matters here because a depressive presentation with a history of mania is a different formulation.

Example: Using SIGECAPS during a clinical interview

A clinician might structure an assessment like this:

Mood: Patient reports depressed mood most of the day, nearly every day, for approximately three weeks.

S: Reports difficulty falling asleep and waking several times during the night.

I: Reports markedly reduced interest in activities previously enjoyed.

G: Reports excessive guilt about perceived failures at work.

E: Reports significant loss of energy.

C: Reports difficulty concentrating during meetings.

A: Reports decreased appetite and approximately 5% unintentional weight loss over the past month.

P: No observable psychomotor agitation or retardation.

S: Denies suicidal ideation or thoughts of death.

The clinician has now documented the individual symptom domains rather than simply writing:

"SIGECAPS positive."

That distinction matters because the latter does not tell another clinician which symptoms are present, how severe they are, or how the diagnostic criteria were evaluated.

How to document SIGECAPS

A useful depression assessment should document the symptoms that are actually present and relevant.

For example:

Depressive symptoms: Patient reports depressed mood, markedly decreased interest/pleasure, insomnia, fatigue, excessive guilt, decreased appetite, and impaired concentration for approximately three weeks. No psychomotor change reported or observed. Denies recurrent thoughts of death or suicidal ideation. Symptoms represent a change from baseline and are causing significant impairment in occupational and social functioning.

This is more useful than:

"SIGECAPS positive."

The clinician should also document what the mnemonic cannot capture: functional impairment, relevant medical or substance factors, and any history of manic or hypomanic episodes. For the last of those, DIGFAST covers the symptom domains to screen. Where substances are involved, the CAGE questionnaire and substance use disorder ICD-10 codes cover screening and coding.

Common SIGECAPS mistakes

Using the mnemonic as the diagnostic criteria

SIGECAPS helps remember symptoms. It does not replace the full DSM-5 assessment.

Forgetting depressed mood

This is the most important mnemonic limitation.

Depressed mood is one of the two required gateway symptoms, alongside diminished interest or pleasure.

Counting symptoms without checking the two-week period

The five-symptom threshold applies to symptoms occurring during the same two-week period.

Treating every symptom as equivalent

Some symptoms are represented broadly in SIGECAPS. For example, appetite/weight change can involve either decreased or increased appetite, while psychomotor symptoms require attention to observable agitation or retardation.

Diagnosing from a checklist alone

A symptom count does not establish the complete diagnosis. The clinician must consider impairment, differential diagnosis, substance or medication effects, medical conditions, and bipolar history.

Documenting "SIGECAPS positive" without details

A reviewer or another clinician cannot determine which symptoms were present or how the diagnostic threshold was established from that phrase alone.

SIGECAPS quick reference

Do not forget: assess depressed mood separately.

Frequently asked questions about SIGECAPS

What does SIGECAPS stand for?

SIGECAPS stands for Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, and Suicide. It is a mnemonic used to remember depressive symptom domains.

What are the nine symptoms of major depression?

The DSM-5 major depressive episode criteria include depressed mood, diminished interest or pleasure, appetite or weight change, sleep disturbance, psychomotor agitation or retardation, fatigue or low energy, worthlessness or excessive guilt, impaired concentration or indecisiveness, and recurrent thoughts of death or suicidal ideation/behavior.

Why does SIGECAPS have only eight letters if DSM-5 has nine symptoms?

SIGECAPS does not explicitly represent depressed mood. The eight letters correspond to the other eight symptom domains. Clinicians should assess depressed mood separately rather than assuming the mnemonic covers all nine DSM-5 symptoms.

How many symptoms are needed for a major depressive episode?

DSM-5 requires five or more symptoms during the same two-week period, with at least one being depressed mood or diminished interest/pleasure. Other diagnostic requirements must also be satisfied.

Does SIGECAPS diagnose major depressive disorder?

No. SIGECAPS is a mnemonic for organizing a symptom assessment. Diagnosis requires evaluation of the complete DSM-5 criteria and relevant differential diagnoses.

How long do the symptoms have to last?

More than two weeks, occurring most of the day, nearly every day, together with a clear change in day-to-day functioning. Five symptoms over several days does not meet the duration criterion.

Which SIGECAPS symptom is most often mis-scored?

Psychomotor change. The criterion refers to agitation or retardation severe enough to be observable by others, not a subjective sense of restlessness or sluggishness. It is the item most likely to be over-endorsed on a self-report measure and under-observed in a short appointment.

Are there other versions of the mnemonic?

Yes, including SIG E CAPS and SIGECAPSS. The letters move around but the gap does not: none of the common versions has a letter for depressed mood, so it has to be asked separately whichever version you learned.

Is SIGECAPS the same as the PHQ-9?

No. SIGECAPS is a clinical mnemonic, while the PHQ-9 is a standardized self-report questionnaire used to assess depressive symptoms and monitor symptom severity. The two can complement each other but should not be treated as interchangeable.

Final takeaway

SIGECAPS is a useful way to remember eight of the nine DSM-5 depressive symptom domains. It is not a standalone diagnostic tool.

The practical rule is:

Assess depressed mood + run through SIGECAPS + confirm 5 or more symptoms over the same 2 weeks + assess impairment and the remaining diagnostic criteria.

The mnemonic is especially useful during a clinical interview because it gives clinicians a quick structure for asking about sleep, interest, guilt, energy, concentration, appetite/weight, psychomotor changes, and suicidality.

But the mnemonic's biggest limitation is also its easiest-to-miss feature: there is no "D" for depressed mood.

For clinicians, the safest use of SIGECAPS is therefore as a memory aid within a broader DSM-5 assessment, not as a substitute for the diagnostic criteria.

Sources

1. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Association Publishing.
2. American Psychiatric Association. What is depression? psychiatry.org
3. Centre for Addiction and Mental Health. Depression: Screening and assessment. camh.ca
4. Lam, R. W., et al. (2016). CANMAT 2016 clinical guidelines for the management of adults with major depressive disorder. Canadian Journal of Psychiatry. pmc.ncbi.nlm.nih.gov

Related guides: PHQ-9 scoring · DIGFAST · OLDCARTS · Medical necessity

Every source above was opened and checked on October 4, 2026. This is educational content and does not replace the DSM-5-TR criteria or clinical judgment.