If the presence of predominantly depressed mood with at least four of the following symptoms persists for more than two weeks, a high degree of caution should be exercised for the possibility of depression (1) Loss of interest and unpleasantness; (2) Loss of energy or fatigue; (3) Psychomotor retardation or agitation; (4) Low self-esteem, self-blame, or feelings of guilt; (5) Difficulty in association or decreased ability to think; (6) Recurrent thoughts of death or suicidal or self-injurious behavior; (7) Sleep disturbances, such as insomnia, early awakening, or excessive sleep; (8) Decreased appetite or significant weight (8) decreased appetite or significant weight loss; (9) decreased sexual desire.