(Select All That Apply): A nurse is teaching a group of nursing students about the diagnostic criteria for major depressive disorder (MDD) according to DSM-5. Which of the following are part of the diagnostic criteria? Select all that apply.

Choice A rationale:

Acetylcholine and gamma-aminobutyric acid (GABA) are not the primary neurotransmitters involved in regulating mood, motivation, reward, cognition, and stress response. Acetylcholine plays a role in memory and muscle control, while GABA is an inhibitory neurotransmitter that helps regulate anxiety and sleep. These neurotransmitters are not as closely associated with the functions mentioned in the question.

Choice B rationale:

Glutamate is a major excitatory neurotransmitter in the central nervous system, and epinephrine (also known as adrenaline) is a hormone that prepares the body for the fight-or-flight response. While both glutamate and epinephrine play important roles in various physiological responses, they are not primarily responsible for regulating mood, motivation, reward, cognition, and stress response as mentioned in the question.

Choice C rationale:

Serotonin, dopamine, and norepinephrine are all key neurotransmitters involved in the regulation of mood, motivation, reward, cognition, and stress response. These neurotransmitters have been extensively studied in the context of mood disorders like Major Depressive Disorder (MDD). Serotonin is often associated with feelings of well-being and happiness, dopamine is linked to pleasure and reward pathways, and norepinephrine is involved in the body's stress response. Imbalances in these neurotransmitters have been implicated in the development of mood disorders.

Choice D rationale:

Endorphins and oxytocin are important neurotransmitters, but they are not as directly related to the regulation of mood, motivation, reward, cognition, and stress response as the neurotransmitters mentioned in choice C. Endorphins are known for their role in pain modulation and feelings of pleasure, while oxytocin is often referred to as the "bonding hormone" and is associated with social connections and childbirth.

Choice A rationale:

Increased interest in activities is not consistent with the clinical presentation of MDD. In fact, a hallmark symptom of MDD is anhedonia, which involves a reduced interest or pleasure in most activities.

Choice B rationale:

Weight gain is not typically associated with MDD. In contrast, significant changes in appetite and weight loss are more common symptoms, often accompanied by feelings of worthlessness or guilt related to body image.

Choice C rationale:

Excessive guilt and self-blame are common cognitive and emotional symptoms of MDD. Individuals with MDD tend to have a negative self-perception and may blame themselves for their difficulties.

Choice D rationale:

Insomnia, or difficulty falling asleep or staying asleep, is a common sleep disturbance associated with MDD. Sleep problems can exacerbate the symptoms of depression and impact overall well-being.

Choice E rationale:

Elevated mood and increased energy are actually more indicative of conditions like bipolar disorder or manic episodes, where there are distinct periods of abnormally elevated mood, known as mania or hypomania.